Single-Port and Multi-Port Robotic Donor Nephrectomy

Abstract

Robotic donor nephrectomy (RDN) has been shown to be a safe and effective method for living donor nephrectomy. RDN can utilize both a multi-port (MP) and a single-port (SP) approach, which share many similarities but differ in certain aspects of the preoperative and intraoperative approach. These differences and the findings of studies reporting clinical outcomes of both the MP and SP approaches are discussed in the following video and written article. In this article, we describe the indications, preoperative preparations, and postoperative care plans for RDN at our institution as well as some of the major differences in the equipment, patient positioning, and port placements for the MP vs SP approaches. We then detail the 12-step surgical technique for both the MP and SP, indicating major differences in how the surgical approach can impact intraoperative measures. Finally, we summarize our recent findings on the clinical success of the MP and SP approaches as compared with laparoscopic approaches and between the MP and SP techniques. Together, our clinical and research experiences have shown that both the MP and SP are safe, feasible, and effective options for living donor nephrectomy. When compared with the laparoscopic technique and when comparing the MP with the SP approaches, they both offer comparable graft outcomes. From our clinical experience, certain aspects of the SP approach may offer advantages during specific steps of the procedure. Future randomized prospective clinical trials are necessary to confirm the findings of our clinical and research experiences and to continue to identify possible benefits or drawbacks of the SP and MP RDN.