Robot-Assisted Laparoscopic Donor Nephrectomy in 12 Steps

Abstract

Introduction:

Robot-assisted laparoscopic donor nephrectomy (RALDN) is an emerging minimally invasive technique for procuring living renal allografts for transplantation. As an alternative to traditional laparoscopy, robotics provides optical magnification and instrument articulation, which can be used in intricate dissection of the vessels and obtaining maximum length for the graft. We provide a reproducible 12-step instruction on our standard left RALDN and results of our initial experience.

Methods:

The patient is placed in the right lateral decubitus position and the robotic ports are placed. The 12 steps of our standard left RALDN include medial reflection of the descending colon, complete mobilization of the spleen, exposure of the gonadal and renal vein, ligation of the adrenal, gonadal, and lumbar vein, mobilization of the kidney laterally and posteriorly, dissection of the adrenal off the upper pole/superior mobilization, dissection of the renal hilum, medial rotation of the kidney and posterior hilum dissection, mobilization and ligation of the distal ureter, placement of the kidney in a specimen bag, ligation of the renal artery and vein, and extraction of the kidney.

Results:

With standardization of RALDN to 12 steps, this technique can initially be performed with comparable outcomes to standard laparoscopic donor nephrectomy. In our institution's initial experience comparing eight RALDN to eight LDN, there were no significant differences found between RALDN and LDN in the mean operative duration (217.4 minutes vs. 190.1 minutes, respectively), warm ischemia time (2:55 vs. 2:13), estimated blood loss (58.8 cc vs. 72.1 cc), length of stay (2.5 days vs. 2.2 days), and 2-week follow-up creatinine (1.33 mg/dL vs. 1.29 mg/dL).

Conclusion:

RALDN can be performed in a reproducible manner based on 12 steps. There is a short learning curve, and outcomes are comparable to standard laparoscopic donor nephrectomy even in an initial experience.

The authors declare that no competing financial interests exist.

Runtime of video: 8 mins 29 secs