Robotic-assisted vs. laparoscopic donor nephrectomy: a retrospective comparison of perioperative course and postoperative outcome after 1 year

Abstract

Safety is of utmost importance in live donor nephrectomies. In this study, we describe our initial experience with robot-assisted laparoscopic donor nephrectomy (RDN) in comparison with the standard laparoscopic donor nephrectomy (LDN). We retrospectively reviewed 95 patients who either underwent RDN or LDN performed by a single surgeon from 2011 to 2016 at a tertiary institution. Donor perioperative course and postoperative outcome along with recipient outcomes were compared. Of the 95 cases, 73 were classified as LDN and 22 were classified as RDN. There were no significant differences between the two groups in age, sex, BMI, race, and ASA status. Operative times (p < 0.001) were longer in the RDN group, but eventually approached LDN times. Warm ischemia (p = 0.002) and extraction times (p = 0.05) were also longer in the RDN cohort. The donor length of hospital stay, complication rates, and postoperative change in eGFR from baseline were similar in both cohorts up to 1 year. Recipient outcomes, including delayed graft function, graft failure, and renal function up to 1 year, were also comparable. In this study, we compared the longest postoperative course so far in both donors and recipients between RDN and LDN. Up to 1 year, RDN does not negatively impact outcomes. Proficiency with RDN also quickly improved to match LDN, making it a suitable procedure for newer surgeons.

Donor and Recipient Outcomes following Robotic-Assisted Laparoscopic Living Donor Nephrectomy: A Systematic Review

“…Mean OT and mean CT ranged from 139 to 306 minutes and from 82 to 120 minutes, respectively. Three comparative studies found mean OT to be significantly longer in RALDN series with respect to LDN [4, 13, 16]. Mean OT of RALDN was also significantly longer than open donor nephrectomy (ODN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARP) [4, 7, 13].…”

“…Similarly, Janki et al found mean OT of RALDN procedures 1-19 to be significantly longer than RALDN procedures 40-59 (median OT of 240 and 172.5 minutes, respectively) [13]. In the study by Yang et al, the OT of RALDN approached that of LDN with each subsequent procedure over the course of the robotic cases and the standard OT of LDN was reached at the 22nd case [16].…”

“…The impact of surgical technique on WIT is controversial. Two comparative studies found significantly longer WIT in patients undergoing RALDN with respect to those undergoing LDN [12, 16]. Two other comparative studies found WIT to be significantly longer in patients undergoing ODN and HARP [7, 13].…”

“…Serrano et al found significantly lower EBL in patients undergoing RALDN compared to ODN, hand assisted LDN (HALDN) and LDN (80 mL, 296 mL, 91 mL, and 130 mL, respectively) with intraoperative transfusion rate of 0%, 0.3%, 0.5%, and 3% in RALDN, HALDN, LDN, and ODN, respectively (p<0.05) [4]. Other authors failed to find statistically significant differences between RALDN and LDN in terms of EBL [10, 13, 16]. One study found EBL to be significantly higher in patients with vascular abnormalities (107 mL vs 72 mL, p<0.05) [3].…”

“…Two other comparative studies found mean hospital LOS to be significantly shorter after RALDN compared to ODN [4, 7]. Five studies failed to find statistically significant differences between RALDN and LDN [1, 4, 10, 13, 16]. Cohen et al found that mean LOS decreased with increasing RALDN experience [5].…”