Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique

Abstract

Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes.Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes.Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6–90) ml/min/1.73 m2. In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195–258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140–255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m2.Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.

The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

“…There are different minimally invasive techniques, including standard pure laparoscopic, hand-assisted laparoscopic, hand-assisted retroperitoneoscopic, pure retroperitoneoscopic, and robotic-assisted live donor nephrectomy [15,16]. Of note, while LDN has become a common practice in most transplant centers around the world due to the benefits that it provides for the donor, the use of robotic-assisted LDN might further improve the outcomes of the procedure, providing distinct benefits, not only for the donor, but also for the surgeon, based on the enhanced dexterity, ergonomic and subsequent confidence of the surgeon that allow for a more standardized and potentially easier procedure, compared to standard laparoscopy, especially in difficult donors with high BMI or complex vascular anatomy [8][9][10].…”

“…Concerning the state-of-the-art indications and techniques/approaches for living donor nephrectomy, the current European Association of Urology (EAU) guidelines on renal transplantation consider LDN as the preferred technique, due to the highly valid evidence confirming its equality to open surgery in terms of patient and graft survival, graft function, urological complications and rejection rates [7]. Moreover, robotic-assisted living donor nephrectomy (RLDN) represents a safe technique and offers a reasonable alternative to conventional laparoscopic surgery in living kidney donation, aiming in maximizing donor safety, minimizing donor discomfort and improving surgeon's ergonomics and confidence [8][9][10].…”

Two- and three-dimensional laparoscopic donor nephrectomy: a comparative study of a single-center experience

“…We consider laparoscopic donor nephrectomy to be one of the most complex operations; moreover, in this procedure, healthy donors with altruistic motivations are subjected to surgical interventions and risks without any expected therapeutic effects. Other recent studies have shown the advantages of robotic laparoscopic donor nephrectomy over traditional 2D laparoscopic donor nephrectomy [ 24 , 25 ]. At the same time, Mulder et al [ 8 ], in a series of 40 operations, showed clinical and economic benefits of using 3D laparoscopic donor nephrectomy before robotic nephrectomy.…”

Robot-Assisted Autonomous Reduction of a Displaced Pelvic Fracture: A Case Report and Brief Literature Review

“…However, it is essential to emphasize that the holy grail of “steps and technique of reduction” remains an art more than a science, and the extensive open surgery was reportedly associated with a high risk of neurovascular injury leading to poor prognosis. With the rapid development of technology in the 21st century, robot techniques have become a powerful tool and an emerging art assisting surgeons to eliminate all kinds of complex barricades [ 4 , 5 ]. Some have been prevailing in PF fixation [ 6 , 7 , 8 ], but few have been introduced to handle the issue of PF reduction, which is both a highly skilled and physically demanding procedure, and often time-consuming.…”