The first 50 robot-assisted donor nephrectomies: Lessons learned

Abstract

Background: Minimally invasive donor nephrectomy (DN) is considered the gold standard, but the role of robot-assisted surgery is still controversial. Objectives: The first 50 robot-assisted DN (RDN) of a urologic transplant department in Germany were retrospectively analyzed. Materials and methods: Patient characteristics as well as intra- and postoperative surgical parameters were obtained. The kidney function of the donor was assessed within 5 years of follow-up. Predictors of postoperative kidney function at discharge and 1 year after RDN were estimated by multivariate regression analysis. Results: RDN has an excellent surgical outcome with low complication rates, short warm (WIT) and cold ischemia time (CIT), little blood loss, and short patient stay. The side of donor nephrectomy does not affect surgical outcome. After RDN, 50% of donors suffer from mild to moderate renal insufficiency without further consequences, as their kidney function does not further decrease. Preoperative eGFR (estimated glomerular filtration rate) and donor age at surgery are the best predictors of postoperative kidney function after RDN. Conclusions: Robot-assisted donor nephrectomy is an excellent alternative to other minimally invasive approaches rendering solid surgical results possible right from the start.