Introduction: Robotic-assisted laparoscopic donor nephrectomy (RALDN) reportedly facilitate better hilar dissection but had associated concerns regarding longer graft retrieval and ischemia times.  The aim of this study is to assess safety and efficacy of an initially introduced RALDN when compared to the routine retroperitoneal laparoscopic living donor nephrectomy (RLLDN) at a single institution transplant program.
Materials and Methods: Data were collected prospectively from 64 consecutive living kidney donors (12 for RALDN subgroup and 52 RLLDN subgroup) at our hospital from May 2018 to August 2019. All donors were approved by our Government Hospital Renal Transplantation Council according to Amsterdam Guidelines. Patient demographics, radiology findings, surgery results and complications were recorded. Primary endpoints were peri-operative parameters, postoperative outcomes and complications.  The surgeons were experienced retroperitoneoscopic using three ports and robotic surgeons using the Da Vinci Si System with three arm robotic ports.
Results: For the entire group, mean age ± SD was 51.7 ± 8.9 years, and 58% were females. Mean BMI was 22.5 ± 2.3 (15.6 - 27.3). There were 54 (84%) left kidneys.  Preoperatively, there were no significant differences between the two patient groups including age, gender, BMI, kidney side, hilar anatomy and ASA status.   For perioperative outcomes, there was no significant differences (P>0.05) comparing RALDN and RLLDN respectively for warm ischemic time (4.75 ± 1.54vs. 4.75 ± 1.38 minutes), operative time (233 ± 46 vs. 216 ± 41 minutes), hemoglobin (g/L) drop (9 ± 5.6 vs. 8.6 ± 7.2), postoperative complications (All Clavien) (16.7% vs. 9.6%), the donor blood creatinine at one month (1.1 ± 0.2 vs. 1.2 ± 0.3 mg/dL), and the recipient blood creatinine at one month (1.2 ± 0.3 vs. 1.4 ± 0.4 mg/dL). There were no open conversions or delayed graft functions in both groups.
Conclusion: This study showed that  RALDN can be safely introduced into living donor program experienced in laparoscopic donor nephrectomy. This allows the program to utilize the operative advantages including better optics and instrument dexterity of the platform in all or selected cases.