Robot-Assisted Laparoscopic Donor Nephrectomy in 12 Steps

Abstract Introduction: Robot-assisted laparoscopic donor nephrectomy (RALDN) is an emerging minimally invasive technique for procuring living renal allografts for transplantation. As an alternative to traditional laparoscopy, robotics provides optical magnification and instrument articulation, which can be used in intricate dissection of the vessels and obtaining maximum length for the graft. We provide a reproducible 12-step instruction on our standard left RALDN and results of our initial experience. Methods: The patient is placed in the right lateral decubitus position and the robotic ports are placed. The 12 steps of our standard left RALDN include medial reflection of the descending colon, complete mobilization of the spleen, exposure of the gonadal and renal vein, ligation of the adrenal, gonadal, and lumbar vein, mobilization of the kidney laterally and posteriorly, dissection of the adrenal off the upper pole/superior mobilization, dissection of the renal hilum, medial rotation of the kidney and p...