Single-center Experience of Robotic-Assisted Donor Nephrectomy with Transvaginal Extraction

Abstract

Abstract Purpose Living donation provides the best available treatment for end-stage renal disease (ESRD). This technique has slowly evolved over the years. Continued innovation is still needed to provide safe, low-complication, and less-invasive surgery for living donors. In this descriptive paper we aim to report on our center’s experience. Methods: 101 female patients donating their kidney between July 2019 and June 2022 were included in this single center retrospective study. 64 patients had hand assisted donor nephrectomy (HDN), 29 robotic assisted donor nephrectomy (RDN) and 8 patients received RDN with transvaginal extraction (TVE). Therapeutic donors (n=4) were excluded from this cohort. Demographic, preoperative, perioperative, and postoperative data including short term, 6 months and 12 months donor and recipient outcomes were collected from electronic health records. Results: This cohort consisted of mostly Caucasian women with a mean BMI of 27±5 kg/m2. RND-TVE patients were older, had more history of abdominal surgeries, were more likely postmenopausal and all of them had simple hilar anatomy. Only the HDN group included patients with complex hilar anatomy. Mean operative time and total post-operative opioid usage was higher in the HDN-TVE group. Estimated median blood loss was comparable in all groups. There were minimal procedurally related intraoperative or postoperative complications reported in the cohort. Conclusions: Overall, RDN with TVE seems to offer low morbidity risk for a very highly functional, female patients. The utilization of computer-assisted surgery has provided an advantage in making this surgery more achievable with few complications for living donors.