SINGLE CENTER EXPERIENCE WITH ROBOT-ASSISTED LIVING DONOR NEPHRECTOMIES

Objectives: Kidney transplantation has become the preferred method of treatment for those with Chronic Kidney Disease (CKD) or End-Stage Renal Disease (ESRD). The development of minimally invasive surgical techniques has given rise to new surgical techniques such as the Robotic Assisted Donor Nephrectomy (RADN). The RADN technique provides advantages such as improved magnification, 3-D vision, and improved maneuverability and accuracy. Our primary objective is to evaluate a single center’s outcomes with the use of robot-assisted living donor nephrectomy versus laparoscopic living donor nephrectomy.

Methods: A retrospective cohort study was conducted analyzing patient demographics (age, gender, ethnicity, and BMI), length of stay, total narcotic use, post-op narcotic utilization from 0-120 hours, anesthesia time, 30-day readmissions, and admission complications between the robotic living donor cohort and laparoscopic living donor cohort at Tampa General Hospital from November 2020 to June 2022.

Results: There were 112 patients in total and 102 patients received the laparoscopic living donor nephrectomy and 10 received the robot assisted living donor nephrectomy. There were no significant differences between the robotic and the laparoscopic group for the demographic variables gender (p = 0.498), ethnicity (p = 0.501), age (p = 0.091), and BMI (p = 0.475). There was a statistically significant difference (p = 0.001) for the length of stay.  The mean length of stay during admission was 1.5 days for the robot assisted group and 2.2 for the laparoscopic group, approximately 16 hours less for the robotic group. There was a statistically significant difference (p = 0.045) between the two groups for total narcotic use. The robotic cohort took an average of 72.3 milligram morphine equivalent (MME) of total narcotic and the laparoscopic cohort took an average of 92.2 MME. There were statistically significant differences between the two groups for postoperative narcotic use from 0-24 hours (p = 0.008), 48-72 hours (p = 0.006), 72-96 hours (p < 0.001), and 96-120 hours (p = 0.01). There was a statistically significant difference (p = 0.042) in 30-day readmissions and the robotic cohort had zero 30-day readmissions.

Conclusion: Overall, the robot assisted living donor nephrectomy group demonstrated shorter length of stay, less total narcotic use, and less 30-day readmissions without significant differences in anesthesia time compared to the laparoscopic cohort in our study.