Robotic Nephrectomy for Living Donation: Surgical Technique and Literature Systematic Review.

Abstract

Background. As compared to traditional laparoscopy, robotic-assisted surgery provides better endowrist instruments and 3-D visualization of the operative field. Studies published so far indicate that living donor nephrectomy using the robot-assisted technique is safe, feasible, and provides remarkable advantages for the patients. Materials and Methods. From five papers reporting detailed descriptions of surgical technique for Robotic-Assisted-Nephrectomy (RAN) in Living-Donor-Kidney-Transplantation (LDKT), we have gathered information about the surgical techniques as well as about patients’ intra- and post-operative outcome. Data from these papers were analyzed together with the data from our own experience (33 cases) so that the total number of analyzed cases was 292. Results. In the analyzed populations, no case of donor death occurred, and no case developed complication above grade 2 of Clavien score. Peri-operative complications occurred in 37/292 patients (12.6%). Accidental acute hemorrhage occurred in 5/292 cases (1.7%). The average overall intra-operative blood loss was 67.8 ml (range: 10-1500 ml). The average warm ischemia time was 3.5 min (range: 0.58-7.6 min). Conversion to the open technique occurred in only four cases (1.3%). The average overall operative time was 192 minutes (range: 60-400 min). The average length of the hospital stay was 2.7 days (range: 1-10 days). Conclusion. Safety and feasibility of the RAN are pointed out in all the reviewed article, both as hand-assisted and as totally robotic technique. RAN appears to be significantly easier for the surgeons and the results are comparable to the ones obtained with the pure laparoscopic technique.