Evolution of robotic nephrectomy for living donation: From hand-assisted to totally robotic technique

Background: The application of robotic-assisted surgery offers EndoWrist instruments and 3-D visualization of the operative field, which are improvements over traditional laparoscopy. The results of the few studies published so far have shown that living donor nephrectomy using the robot-assisted technique is safe, feasible, and offers advantages to patients. Materials and methods: Since November 2009, 16 patients have undergone robotic-assisted living donor nephrectomy at our Institute. Patients were divided into two groups according to the surgical technique adopted for the procedure: Group A, hand-assisted robotic nephrectomy (eight patients); Group B, totally robotic nephrectomy (eight patients). Results: Intra-operative bleeding was similar in the two groups (90 vs 100mL for Group A and B, respectively). Median warm ischemia time was significantly shorter in Group A (2.3 vs 5.1min for Group A and B, respectively, P-value=0.05). Switching to the open procedure was never required. Median operative time was not significantly longer in Group A than Group B (275min vs 250min, respectively). Conclusion: Robotic assisted living kidney recovery is a safe and effective procedure. Considering the overall technical, clinical, and feasibility aspects of living kidney donation, we believe that the robotic assisted technique is the method of choice for surgeon's comfort and donors' safety