Robotic-Assisted Versus Laparoscopic Hand-Assisted Live Donor Nephrectomy

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Abstract

Background

Live donor nephrectomy (LDN) allows preemptive and timely renal transplantation with optimal clinical outcomes for patients with end stage renal failure (ESRF). Currently living donor transplantation accounts for almost half of all renal transplantations in Switzerland. In view of a growing living donor pool, and its maximal benefit for patients with ESRF, surgical technique must be optimized to protect donor safety and welfare. Herein, we compare two minimally invasive surgical approaches, robotic-assisted versus laparoscopic hand-assisted, for LDN.

Methods

A retrospective study comparing robotic-assisted (n=25) versus laparoscopic hand-assisted (n=36) approaches utilized in 2 different centres for LDN over a 2-year period in 2014-2015.

Results

All LDNs, robotic or laparoscopic, were completed without conversion to open donor nephrectomy. Patient demographics were comparable in both groups in age (robotic: 53yrs±10 vs laparoscopic: 53yrs±12; p=ns), BMI (25kg/m2±5 vs 25kg/m2±4; p=ns) whilst female donors dominated (64%F vs 50%F; p=ns). Left sided nephrectomy was favoured in the robotic group (23L:2R, 92%L vs 18L:18R, 50%L, p=0.01). Operative time of robotic surgery was longer with additional docking time than laparoscopic surgery (309mins±50, range 244-435 vs 135mins±23, range 94-187; p<0.01) nevertheless the warm ischaemic time was comparable in both groups (214secs±66 vs 218secs±74; p=ns). There were no perioperative complications necessitating reoperation. Length of hospital stay tended to be shorter in the robotic group (median 4days, range 2-13 vs 6days, range 3-8; p=0.09) with majority of patients discharged within 4 days (15/25, 60% vs 10/36, 27%; p=0.02) compared to a smaller portion of patients in the laparoscopic group. Reduction of donor renal function was measured as a ratio of creatinine at discharge vs. pre-operatoire, which was higher in the robotic group (1.58±0.32 vs 1.40±0.22; p=0.01); probably due to earlier discharges. In this group, the donor creatinine was 114μmol/l±21 (range 68-168) and recipient creatinine at 132μmol/l±34 (range 89-227) both measured at discharge. Postoperative complications developed in 2 patients in each group; 2 Clavien II (chest infection, wound infection) in the robotic and 2 Clavien III (abdominal wall abscess, incisional hernia) in the laparoscopic group.

Conclusion

Robotic-assisted LDN was safe and feasible. Operative time was longer in robotic surgery nevertheless the warm ischaemic time was comparable to the laparoscopic approach; ultimately, the length of hospital stay tended to be shorter. In view of a growing living donor pool and its maximal benefit for patients with ESRF, minimally invasive surgery in form of robotic-assisted LDN may be an avenue for optimal recovery.

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