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

World Journal of Surgery, vol. 48, pp. 1958–1966

Abstract

BACKGROUND: In June 2021, the first robot-assisted donor nephrectomy (RADN) was performed at the Leiden University Medical Center (LUMC), the Netherlands. The goal of this study was to investigate whether this procedure has been implemented safely and efficiently. METHODS: RADN was retrospectively compared to laparoscopic donor nephrectomy (LDN) performed during the same time period (June 2021 until November 2022). Patients were assigned to RADN depending on the availability of the da Vinci robot and surgical team. The studied endpoints were postoperative complications, operative time, estimated blood loss, warm ischemic time (WIT), and postoperative pain experience. For analysis, the Student's t-test and Chi-squared test were used for, respectively, continuous and categorical data. RESULTS: Forty RADN were compared to 63 LDN. Total insufflation time was significantly longer in RADN compared to LDN (188 min (169-214) versus 172 min (144-194); p = 0.02). Additionally, WIT was also found to be significantly higher in the robot-assisted group (04:54 min vs. 04:07 min; p < 0.01). No statistical differences were found in postoperative outcomes (eGFR of the recipient at 3-month follow-up, RADN 54.08 mL/min ±18.79 vs. LDN 56.41 mL/min ±16.82; p = 0.52), pain experience, and complication rate. CONCLUSION: RADN was safely and efficiently implemented at the LUMC. It's results were not inferior to laparoscopic donor nephrectomy. Operative time and warm ischemic times were longer in RADN. This may relate to a learning curve effect. No clinically relevant effect on postoperative outcomes was observed.

Authors 11

1. Emma F. van de Geijn corresponding Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

2. Shiromani Janki Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

3. Dorottya K. de Vries Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

4. Willemijn N. Nijboer Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

5. Ian P.J. Alwayn Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

6. Jeroen Nieuwenhuizen Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

7. Andrzej G Baranski Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

8. Alexander F. Schaapherder Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

9. Aiko P. J. de Vries Aachen Department of Internal Medicine Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Internal Medicine Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

   Department of Internal Medicine, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

10. Volkert A.L. Huurman Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

    Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands

11. Hwai‐Ding Lam Aachen Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands Department of Surgery, Transplant Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery Transplant Center Leiden University Medical Center (LUMC) Leiden Zuid Holland Netherlands

    Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands