Single-Port Robotic Extraperitoneal Donor Nephrectomy: Technique and Initial Case Series

Minimally invasive donor nephrectomy is the gold standard for reducing donor morbidity, yet transperitoneal approaches carry inherent risks. The extraperitoneal approach offers a potentially safer alternative. We present our initial experience with Single-Port Robotic Extraperitoneal Donor Nephrectomy (SP-REDN), a novel technique utilizing the da Vinci SP system to navigate the retroperitoneal space through a single 5-cm incision that serves as both the operative port and the graft extraction site. Between September 2025 and March 2026, 13 living donors underwent SP-REDN. Five donors (38.5%) had a history of prior abdominal surgery. Our technique utilizes a muscle-sparing anterior rectus sheath incision in supine position. Mean operative time was 180.5 minutes (SD 42.9), with a mean WIT of 6.2 minutes (SD 6.7). There were no open conversions or immediate complications, and the median hospital stay was 2.0 days (IQR 1.0-2.0). This series demonstrates that SP-REDN has the potential to optimize both donor safety and experience by avoiding peritoneal violation and offering a single-incision approach.