Robotic versus open mini incision living donor nephrectomy: Single center experience
Seung Duk Lee1, Aamir Khan1, Amit Sharma1, Adrian Cotterell1, Vinay Kumaran1, David Bruno1, Marlon Levy1, Chandra Bhati1.
1Hume Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, United States
Background: Minimal invasive approach is a gold standard procedure for living donor nephrectomy (LDN). Laparoscopic, hand-assisted laparoscopic and mini-incision open techniques are established minimal invasive donor nephrectomy technique. While the use of robotics for native nephrectomies and the urological procedure is fairly common, robotic LDN is being performed at a very few centers worldwide. The robotic platform provides three-dimensional vision and replication of the human hand. Which presumed to result in less tissue manipulation and early recovery. The present study aimed to compare the short-term outcomes between robotic-assisted donor nephrectomy (RDN) and open mini-incision donor nephrectomy (ODN) at a single center.
Methods: From 2016 to 2019, 141 consecutive cases involving RDN were analyzed at our single center. Outcomes of these patients were compared with a historical cohort (2010-2015) who underwent open mini-incision (7-9cm) donor nephrectomy. These patients were frequency-matched according to sex, race, and laterality of donor organ.
Results: A total of 141 patients successfully underwent RDN, while 141 of 224 patients who underwent ODN were selected for a frequency-matched comparison. The RDN and ODN groups had a mean age of 42.8 and 41.3 years old, respectively (p=0.30) as well as a mean BMI of 27.1 and 27.1 (p=0.99). The left donation was performed in 102 patients (70.9%) in both groups. Operative time was similar between both groups (194.32 for RDN vs. 198.23 min for ODN, respectively; p = 0.45). The RDN group presented with less blood loss than the ODN group (37.45 vs. 82.34 ml; p = 0.038). There was no open conversion case in the RDN group. Postoperative creatinine and glomerular filtration rate were not significantly different between two groups (1.28 and 61.68 for RDN vs. 1.29 mg/dL and 63.23 ml/min for ODN; p = 0.924 and 0.346, respectively). The hospital stays in the RDN group showed significantly less than those in the ODN group (2.34 vs. 3.06 days; p <0.001, respectively). There were complications including stump bleeding (3 for RDN vs 1 for ODN, p = 0.622), urinary retention (1 for RDN vs 3 for ODN, p = 0.622), and lymphatic leak (1 for RDN vs. 0 for ODN, p >0.99).
Conclusions: RDN is a safe minimal invasive technique with excellent outcomes. The robotic approach has a benefit of early recovery and shorter hospital stays.
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