Abstract
Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes.Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes.Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6–90) ml/min/1.73 m2. In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195–258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140–255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m2.Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.
Highlights
Live kidney donors are healthy individuals who intentionally undergo major surgery to improve the well-being of another individual; as such, maximizing the donor safety during this procedure is of paramount importance.Several surgical techniques have been described for living donor nephrectomy (LDN), including open, pure or handassisted laparoscopic, natural orifice transluminal endoscopic surgical (NOTES) and robotic approaches [1,2,3,4].In this view, minimally invasive techniques are increasingly being performed worldwide with the aim to further limit the morbidity of surgery for the donors while ensuring optimal grafts for kidney transplantation [5]
In this report we provide a step-by-step overview of the University of Florence technique for robotic LDN, focusing on its technical nuances and perioperative outcomes
36 robotic LDNs were performed at our Center by a single surgeon during the study period
Summary
Live kidney donors are healthy individuals who intentionally undergo major surgery to improve the well-being of another individual; as such, maximizing the donor safety during this procedure is of paramount importance.Several surgical techniques have been described for living donor nephrectomy (LDN), including open, pure or handassisted laparoscopic, natural orifice transluminal endoscopic surgical (NOTES) and robotic approaches [1,2,3,4].In this view, minimally invasive techniques are increasingly being performed worldwide with the aim to further limit the morbidity of surgery for the donors while ensuring optimal grafts for kidney transplantation [5]. While laparoscopic living donor nephrectomy (LDN) has become a common procedure in most Transplant Centers and has been shown to be associated with shorter hospital stay, less pain, and faster recovery as compared to open surgery [6, 7], the use of robotic surgery in this setting might further improve its perioperative outcomes providing distinct benefits for both donors and surgeons [1]. This is mainly due to the advantages of the robotic platform as compared to standard laparoscopy (improved ergonomics, Endowrist technology, magnification and 3D vision). Robotic LDN has been implemented and is being increasingly performed at referral Centers with expertise in both living donor kidney transplantation and robotic surgery [8,9,10], with excellent outcomes, comparable to those of pure laparoscopic LDN [1]
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