Can a robotic donor nephrectomy be an alternative to laparoscopic nephrectomy?

Previous studies have shown that the outcomes of these robotic procedures are no worse than pure laparoscopic or hand assisted donor nephrectomies (LDN). Our aim was to further investigate the difference in outcomes between these techniques of living donor kidney transplantation. This is a retrospective study comparing surgical techniques for live donor nephrectomies. The results of 50 consecutive live donor nephrectomies performed from 2016- 2018, 36 laparoscopic followed by 14 robotic, were reviewed. The two surgical approaches were compared by collecting information on operative length, intraoperative blood loss, intraoperative fluid administered, PRN opioids administered in hospital, length of stay, and creatinine at discharge. Overall, donor demographics and clinical characteristics were similar between groups. In the RDN and LDN samples, operations were performed on patients with similar gender distribution (72% vs. 67% female p=0.75), BMI (26.4 vs. 27.3 p= 0.45), and age (40.9 vs 47.3 p=0.13). Left nephrectomies were dominant in both groups (57% vs. 51% p=0.73). Robotic and Laparoscopic operative techniques were found to have similar operative length (258min vs 264min p=0.80) and blood loss (118mL vs 148mL p=0.60). Robotic donor nephrectomies required significantly less intraoperative fluid replacement than their laparoscopic counterparts (3.2L vs 4.4L p=0.005). There was no statistical difference in creatinine at discharge (1.05 vs 1.38 p=0.36). RDN patients experienced an 8% decreases in average length of stay (3.14 vs. 3.42 days p=0.68) and a 4% decrease in Morphine milligram equivalents administered during their stay (313 vs. 327 p=0.83). This study continued to show that RDN is a safe and effective alternative surgical approach when compared to LDN. The decreases in operative time, blood loss, and fluid administration may reflect the decreased tissue manipulation allowed for by robotic assistance. This could be one of the factors that lead to shorter hospital stays and fewer narcotic requests.