Background: Kidney transplantation (KT) provides increased survival for patients with end-stage renal disease (ESRD). Living donation (LD) is a cornerstone in the increase of the pool of donors available, especially due to recipients requiring less time on the waitlist and need for ongoing dialysis along with evidence for longer graft survival. One of the barriers for LD is the burden of the procurement surgery, that has traditionally been performed by open or laparoscopic hand-assisted technique. We report here a case series of 22 patients submitted to robotic-assisted left donor nephrectomy.

Methods: Prospectively collected data of patients submitted to robotic-assisted left donor nephrectomies at the Jackson Memorial Hospital, University of Miami, Miami Transplant Institute, in the period of Aug-2021 to Mar-2022, during the first phase of implantation of the Transplant Robotic Program. Data relative to the pre-operative, intra-operative and post-operative periods were collected, including clinic-demographic characteristic of the patients, surgical metrics, and pathology findings. Continuous variables were analyzed with Student t-test, categorical variables were analyzed with chi-square test. A p-value of less than 0.05 was considered to be statistically significant.

Results: 22 patients were included, of those 10 (45.5%) were male. The median age was 40 (30-49.3) years old. Of all cases analyzed, 16 (72.7%) donated the kidney to a related family member. The donor kidney graft anatomy was conventional (single artery, single vein, single ureter) in 19 (86.4%) of the cases. There was 1 (4.5%) case with multiple arteries that was successfully reconstructed in the back-table operation.  There were anatomical technical difficulties in 5 (22.7%) cases. A Pffanenstiel incision was used in 10 (45.5%) cases for graft extraction from the abdomen. The median extraction time was 90.5 (IQR 56.5-225.2) seconds. The median intra-operative robotic console time was 102 (IQR 89.8-119.2) min. Robotic stapler devices were used in 21 (95.5%) cases. Foley catheter was removed in the operating room in 21 (95.5%) cases. The median length of stay was 1.23 (IQR 1.0-1.4) days. Graft function was immediate in 20 (90.1%) of the cases, and slow in 2 (9.9%) cases. Macroscopic procurement damage was appreciated in 5 (22.7%) cases. There was 1 (4.5%) postoperative readmission, 4 (18.2%) postoperative complications, and no surgical re-intervention needed. None of the patients had to be converted to laparoscopic or open operation associated to the procedures. There was no statistically significant difference between the groups analyzed.

Conclusion: Robotic-assisted left donor nephrectomy is a safe procedure associated with minor risk of complications, and should be stimulated in the transplant centers where robotic surgery is available.