Abstract
Living kidney donation is the best treatment for end-stage renal disease, however, the best surgical approach for minimally-invasive donor nephrectomy (DN) is still a matter of debate. This bi-centric study aimed to retrospectively compare perioperative outcomes and postoperative kidney function after 257 transperitoneal DNs including 52 robot-assisted (RDN) and 205 laparoscopic DNs (LDN). As primary outcomes, the intraoperative (operating time, warm ischemia time (WIT), major complications) and postoperative (length of stay, complications) results were compared. As secondary outcomes, postoperative kidney and graft function were analyzed including delayed graft function (DGF) rates, and the impact of the surgical approach was assessed. Overall, the type of minimally-invasive donor nephrectomy (RDN vs. LDN) did not affect primary outcomes, especially not operating time and WIT; and major complication and DGF rates were low in both groups. A history of smoking and preoperative kidney function, but not the surgical approach, were predictive for postoperative serum creatinine of the donor and recipient. To conclude, RDN and LDN have equivalent perioperative results in experienced centers. For this reason, not the surgical approach, but rather the graft- (preoperative kidney function) and patient-specific (history of smoking) aspects impacted postoperative kidney function.
Highlights
Living kidney donation is the ultimate treatment for end-stage renal disease (ESRD) [1]
The number of organs with multiple arteries was no different between robot-assisted DN (RDN) and laparoscopic DNs (LDN) (11.5% vs. 18.5%), but significantly more grafts in the LDN group had multiple veins (12.7% vs. none, p < 0.01)
Minimally-invasive surgical techniques have increased the acceptance of living kidney donation, but its high variability renders head-to-head comparisons of surgical approaches a complex task
Summary
Living kidney donation is the ultimate treatment for end-stage renal disease (ESRD) [1]. Minimally-invasive approaches for donor nephrectomy (DN) have increased the incidence of living kidney donation since the first laparoscopic DN (LDN) in 1995 and the first robot-assisted DN (RDN) in 2000 [3,4,5]. Others have even tried to perform DN as a NOTES (natural orifice transluminal endoscopic surgery), and Pietrabissa et al were the first to report a transvaginal extraction of the kidney after RDN in 2010 [10]. The robotic approach still accounts for less than 5% of all minimally-invasive DNs, with increasing incidence compared to conventional transperitoneal LDN at more than 50% [13]
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