Robotic-assisted laparoscopic donor nephrectomies: Early experience and review of the literature

With over 80,000 patients in the United States awaiting kidney transplantation, renal transplant surgery continues to evolve with attractive surgical options for living donation, which include laparoscopic donor nephrectomy (LDN) and robotic-assisted laparoscopic donor nephrectomy (RALDN). LDN is currently accepted as the gold standard procedure for living donor nephrectomy; RALDN is an evolving technique and may emerge as a preferred procedure over time. We present our initial experience with RALDN from December 2007 to August 2008. Thirty-five patients who underwent RALND were retrospectively analyzed and compared with 35 age- and time (year)-matched patients who underwent LDN. The parameters analyzed were length of hospital stay (3.2 ± 0.9 days, P < 0.59), estimated blood loss (146 ± 363 ml, P < 0.36), operating time (149 ± 44 min, P < 0.23), cold ischemic time (135 ± 202 min, P < 0.19), preoperative creatinine (0.82 ± 0.26 mg/dl, P < 0.46) and postoperative creatinine (1.44 ± 1.03 mg/dl, P < 0.20). There was no statistical difference between RALDN patients with single renal artery (n = 27) and those with more than one renal artery (n = 8) kidneys. There was one serious complication requiring conversion to open laparotomy to control a bleeding renal artery stump following extraction of the kidney. One-year graft survival for the 35 recipients of RALDN was 97.1%. RALDN is feasible and compares favorably to the standard LDN procedure with good graft survival. Robotic-assisted transplant surgery is an emerging technique with potential benefits to both surgeon and patient.