3D Endoscopic Donor Nephrectomy Versus Robot-Assisted Donor Nephrectomy: a Detailed Comparison of Two Prospective Cohorts

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Abstract

Background

Visual misperception during endoscopic surgery could be overcome by restoring three-dimensional (3D) view. Both the 3D endoscopy and da Vinci® surgical system implement this 3D vision. Compared to the robot, 3D endoscopy has several advantages, such as the presence of tactile feedback. We aimed to assess whether 3D endoscopy could be an alternative to the robot during living donor nephrectomy (LDN).

Methods

Between April 2015 and April 2016 we prospectively collected data on patients undergoing 3D endoscopic LDNs in one center. Pre-, intra- and post-operative data until three months after surgery, as well as information on recipient and graft survival were acquired. These data were compared to robot-assisted donor nephrectomies (RADNs) performed in the same center.

Results

Forty 3D endoscopic procedures were compared to 40 RADNs, all performed by two identical surgeons. Baseline characteristics were comparable. Intraoperative results showed a significantly shorter median skin-to-skin time (STS-time) of 138.5 min. (125.8-163.8) versus 169.0 (141.5-209.8) min., warm ischemia time ([WIT], P=0.003), and hilar phase for both single- and multiple anatomies (P=0.002 and P=0.010, respectively) in favour of the 3D group. Hospital stay for donors in this group was significantly shorter (P<.001). Three-month post-operative outcomes demonstrated no significant differences for donors, recipients and graft survival.

Conclusions

3D endoscopy for LDN seems to be a good alternative; it is safe for the donor and easy to adapt for surgeons, with a significantly shorter STS-time. Both the hilar phase and WIT were also significantly reduced, without differences in recipient or transplant outcomes.

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