Background: A minimally invasive approach is gold standard for living donor nephrectomy (LDN). Traditionally robotic surgery is commonly used for native nephrectomies and urological procedures, robotic LDN is being performed at very few centers worldwide. The robotic platform allows three-dimensional imaging of the surgical site and precise replication of human hand movements scaled down. Robotic surgery is associated with less tissue manipulation and earlier recovery with minimal incision. The aim of this study is to compare the short-term clinical outcomes between robotic-assisted donor nephrectomy (RDN) and open mini-incision donor nephrectomy (ODN) at a single center.

Methods: From 2016 to 2019, 141 consecutive cases involving RDN were analyzed at our single center. Patient outcomes were compared with those from a historical cohort of 191 patients who underwent ODN (7-9 cm incision) from 2010 to 2015. Medical records, including demographics, operation factors, perioperative outcomes, and complications were reviewed retrospectively.

Results: The RDN and ODN groups had a mean age of 42.8 and 41.4 years old, respectively (p = 0.31) as well as a mean BMI of 27.1 and 27.2, respectively (p = 0.76).  Left-sided donor nephrectomy was performed in 102 patients (72.3%) via robotic approach and 88 patients (44.7%) via open approach (p < 0.001). Operative time was similar between both groups (194.0 for RDN vs. 197.8 min for ODN, respectively; p = 0.40). The RDN group presented with less blood loss than the ODN group (37.5 vs. 79.3 ml; p = 0.023). There was no open conversion case in the RDN group. Postoperative creatinine and glomerular filtration rate were not significantly different between two groups (1.28 and 61.68 for RDN vs. 1.28 mg/dL and 64.26 ml/min for ODN; p = 0.996 and 0.098, respectively). Length of hospital stay was significantly shorter in the RDN group than the ODN group (2.34 vs. 3.08 days; p <0.005). The overall rate of complications was low and there was no statistically significant difference in complication rates between the groups. Complications included stump bleeding (3 for RDN vs 1 case for ODN, p = 0.313), urinary retention (1 for RDN vs 3 cases for ODN, p = 0.643), lymphatic leak (1 for RDN vs. 0 case for ODN, p=0.417).

Conclusions: RDN is a safe and minimally invasive technique with excellent clinical outcomes for living donors. The robotic approach has benefits over the traditional open approach, including shorter length of hospital stay and reduced intraoperative blood loss.