Surgical techniques for robotic donor nephrectomy using the single-port robotic platform

Recent studies have shown comparable outcomes between robotic and laparoscopic donor nephrectomy. Since its FDA approval in 2018, the da Vinci single-port (SP) robotic surgical system has been used for a variety of urologic robotic cases, including more recently, SP robotic donor nephrectomy (SP RDN). We evaluated the outcomes of SP RDN at our institution and discussed the surgical steps and operative considerations when performing SP RDN. 51 donors underwent SP RDN from 9/1/2020 to 7/1/2024 at our institution. Patients were placed in modified flank position and the robotic platform was docked following a 7 cm Pfannenstiel incision and a 12 mm umbilical assistant port placement. Surgical steps included 1) medial reflection of colon and accessing the retroperitoneum, 2) splenic mobilization, 3) exposure of gonadal and renal vein, 4) ligation of adrenal, gonadal, and lumbar vein, 5) dissection of renal hilum, 6) mobilization of upper pole of kidney, 7) lateral and posterior mobilization of kidney, 8) mobilization and ligation of ureter, 9) extraction preparation, 10) ligation of renal artery and vein, 11) kidney extraction. Mean operative, extraction, and warm ischemia times as well as hemoglobin change and length of stay were in line with current literature. Postoperatively, mean donor eGFR ranged was 67.21 mL/min/1.73m² at 2-weeks and 70.1 mL/min/1.73m² at 1-year. Recipient post-op eGFR was 62.9 mL/min/1.73m² by postoperative day 3 and 59.3 mL/min/1.73 m at 1-year. Postoperative 30-day emergency department visit and hospital readmissions were both 1.9 % (1/51). Clavien-Dindo II-IV complications occurred in 9.8 % of patients. Overall, SP RDN is a novel approach to donor nephrectomy, which provides excellent visualization and degrees of freedom that allow surgeons to tackle complex vascular anatomy while reducing number of laparoscopic incisions.