Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Abstract

Objectives: The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success. Methods: Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated. Results: Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m 2 , respectively. At six week’s follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m 2 . Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant. Conclusion: Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.

Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015–2023

“…Overall, seven patients successfully underwent RADN, no major complications were reported, and mean hospitalization day was 2.1 days. 118…”

Effective and safe implementation of robot‐assisted donor nephrectomy by experienced laparoscopic surgeons

“…Well performed randomized controlled trials and meta-analyses are limited. [7][8][9][10][11][12][13][14] When implementing this new technique, one should be aware of the learning curve, which indicates longer operative times for the first RADN procedures; however, these times can improve over time. 8,15,16 At the Leiden University Medical Center (LUMC) Transplant Center, Leiden, the Netherlands, kidney, liver, (kidney) pancreas and islet of Langerhans transplantations are regularly performed.…”

The Impact of Learning Curve on Robotic Living Donor Nephrectomy Outcomes

“…7 Perhaps the most substantial recent development in the technique of living donor nephrectomies is the shift to minimally invasive procedures, speci cally the robot assisted living donor nephrectomy (RDN). [8][9][10] Studies have shown that RDN procedures have less blood loss and patients have less postoperative pain, lower risk of post-operative complications (surgical site infection and incisional hernia), and shorter hospital stays compared to their laparoscopic counterparts. [11][12][13] However, longer operative times have also been reported with RDN.…”