Abstract
Main Problem: Robotic-assisted techniques are common for living-donor nephrectomy. While robotic stapling offers increased surgeon control, there is limited comparative data versus laparoscopic linear stapler use for ligation of renal vessels.
 Methods: We retrospectively reviewed 32 consecutive robotic-assisted donor nephrectomies by a single surgeon for perioperative outcomes.
 Results: Patients in the robotic stapler (RS; N=20) and laparoscopic stapler (LS; N=12) groups were comparable in terms of age and BMI. Estimated blood loss (p = 0.62), warm ischemia time (p=0.50), and console time (p=0.56) were similar between the RS and LS groups. There were no stapler misfires or major intraoperative complications in either group and no cases required conversion to open.
 Conclusions: Robotic stapler use is safe and effective in robotic-assisted donor nephrectomy. Further research on prevalence of robotic stapler use is needed to quantity the associated complication rate.
 
Highlights
Renal transplantation is the preferred form of renal replacement therapy for patients with end stage renal disease [1]
The mortality rate of living donor nephrectomy has been reported as 0.02% to 0.04% [3], with a complication rate of approximately 3 to 30% [4,5]
Multiple stapler loads were used in cases of Relevant variables were abstracted from medical records for each case including estimated blood loss (EBL), length of stay (LOS), warm ischemia time (WIT), and robotic console times
Summary
Thirty-two consecutive robotic-assisted donor nephrectomies by a single surgeon were retrospectively reviewed. Cases were stratified by the technique used to secure the renal vessels: robotic with robotic stapling (RS) or robotic with handheld laparoscopic stapling (LS). The da Vinci SureFormTM stapler (Intuitive Surgical, Sunnyvale, CA, USA) with 45 mm loads was used for robotic cases. A single vascular load was used for taking each vessel. Relevant variables were abstracted from medical records for each case including estimated blood loss (EBL), length of stay (LOS), warm ischemia time (WIT), and robotic console times. WIT was computed from the charted time of renal artery stapling to the charted time the graft was placed on ice. Robotic console time was computed as the time from robotic docking to robotic undocking, as charted in the medical record by the circulating nurse. All variables were compared using two-tailed Mann-Whitney U tests with level of significance 0.05
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