Robot-Assisted versus Laparoscopic Donor Nephrectomy: A Comparison of 250 Cases

Abstract

Living kidney donation is the best treatment for end-stage renal disease, however, the best surgical approach for minimally-invasive donor nephrectomy (DN) is still a matter of debate. This bi-centric study aimed to retrospectively compare perioperative outcomes and postoperative kidney function after 257 transperitoneal DNs including 52 robot-assisted (RDN) and 205 laparoscopic DNs (LDN). As primary outcomes, the intraoperative (operating time, warm ischemia time (WIT), major complications) and postoperative (length of stay, complications) results were compared. As secondary outcomes, postoperative kidney and graft function were analyzed including delayed graft function (DGF) rates, and the impact of the surgical approach was assessed. Overall, the type of minimally-invasive donor nephrectomy (RDN vs. LDN) did not affect primary outcomes, especially not operating time and WIT; and major complication and DGF rates were low in both groups. A history of smoking and preoperative kidney function, but not the surgical approach, were predictive for postoperative serum creatinine of the donor and recipient. To conclude, RDN and LDN have equivalent perioperative results in experienced centers. For this reason, not the surgical approach, but rather the graft- (preoperative kidney function) and patient-specific (history of smoking) aspects impacted postoperative kidney function.

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

“…However, others report even shorter length of stays for RAPN ranging from 3 to 5 days 15,30 . This can be attributed to differences in national health care systems, as German reimbursement covers a longer hospital stay 32–34 . In fact, patients could have been discharged earlier from a surgical point of view, but it has not been a crucial parameter for us, either for RAPN or OPN.…”

Does the Side Matter? A Retrospective Cohort Study Comparing Left and Right Pure Laparoscopic Donor Nephrectomies

“…LDN was performed with a pure laparoscopic technique as described previously [12, 13]. In brief, 4 ports were used, the surgery was conducted without hand-assistance and the kidney was extracted through an enlarged lateral trocar incision measuring 5–6 cm [14]. All kidney transplantations (KTs) were conducted in an open extraperitoneal approach to the iliac fossa.…”

Robotisch assistierte Nierenlebendspende – technische Aspekte und erste Evidenz

“…Die Angaben zu Operationszeit und Warmischämiezeit variieren. In einer kleineren amerikanischen Serie von 58 Patienten waren Operations-und Warmischämiezeit bei den robotisch assistierten Ein-griffen signifikant verlängert [25,26], während in einer größeren deutschen Serie von 257 Lebendspenden (davon 52 robotische und 205 laparoskopische Entnahmen) kein Unterschied festgestellt werden konnte [27]. Hier ist sicherlich insbesondere die Lernkurve zu berücksichtigen, die in einer niederländischen Serie von 29 Patienten und einer amerikanischen Serie von 214 Patienten eindrücklich beschrieben wurde [24,28].…”