The Robotic Living Donor Kidney Donation: Technical Aspects and Results

Background. Living donor kidney transplantation is the best option for patients with end-stage renal disease, in terms of both patient and graft survival. Minimally invasive donor nephrectomy represents the standard of care for living donors and robotic technique appears to be safe and increasingly widespread. The aim of this study was to report technical aspects and results of full Robotic Living Donor Nephrectomy (RLDN) at our center, with particular focus on surgical complications and outcomes. Materials and methods. In November 2019, a RLDN program has been established at our institution. A multidisciplinary board evaluated all potential donors and the nondominant kidney was selected. All cases were performed with daVinci® Surgical System in a three-arm configuration. Full RLDN was adopted with a Kustner fascial incision for extraction of the graft in an Endo- Catch®. Results. Thirty-eight consecutive RLDN were performed at our center: 11 right and 27 left. Median donor age was 54.7 years and median donor body mass index was 24.7 kg/m2. In all cases, RLDN was carried out without need of open conversion and intraoperative complications and with minimal blood loss. Median surgical time was 240 min and median warm ischemia and cold ischemia times were 3.38 min and 79 min, respectively. The median hospital stay was three days; four cases of Clavien-Dindo complication grade 2 occurred. None of the recipients experienced delayed graft function. Conclusions. RLDN can achieve optimal functional outcomes for both donor and recipient. Full RLDN is a feasible, safe and effective technique in experienced hands and in highly specialized transplant centers, able to ensure optimal perioperative and functional outcomes.