Totally Robotic Donor Nephrectomy for Living Donors Using a Novel Technique: Single-Center Experience

Objectives: Robot-assisted laparoscopic donor nephrectomy for living donor transplant debuted successfully in the year 2000 and has since gained global acceptance. We assessed our practice of robot-assisted living donor nephrectomy and applied an innovative technical approach. Materials and Methods: We conducted a retrospective analysis of data from patients who underwent robot-assisted living donor nephrectomy for the period from January 2015 to December 2023. The patient group who had undergone the modified surgical technique was included in the study. We recorded and evaluated the following characteristics: age, sex, body mass index (measured in kilograms body mass per meter squared), donor-recipient relationship, site of operation (right or left side), operation time, warm ischemia time, intraoperative complications, mean estimated blood loss, transfusion requirements, and graft status. Results: There were 55 donors in the study (24 female, 31 male), with a median body mass index of 28 (range, 19-32) and a median age of 43 years (range, 19-65 years). The donor-recipient relationships were as follows: parent in 26 (47%), spouse in 8 (15%), first-degree relative in 9 (16%), and second-degree, third-degree, and fourth-degree relatives in 12 cases (22%). Median operation time was 134 minutes (range, 123-278 minutes). Right kidney nephrectomy was performed in 8 of 55 donors, and left kidney nephrectomy was performed 47 of 55 donors. No graft loss occurred among the recipients. Conclusions: Our experience with this new technique confirmed the feasibility of robotic nephrectomy for living donor kidney transplant as a safe and effective procedure. Notwithstanding the beneficial aspects, the primary drawback of this procedure is its significant cost, thereby necessitating attention toward substantial reduction of the associated expenses in the future by development of new techniques such as those we have described in this study.