title: Initial experience with robot-assisted nephrectomy for living-donor kidney transplantation: feasibility and technical notes.
abstract: BACKGROUND
  Robot-assisted surgery provide endowrist instruments and 3-dimensional visualization of the operative field that are improvements over traditional laparoscopy. The few research studies published so far have demonstrated that living-donor nephrectomy using the robot-assisted technique is safe and feasible, providing advantages for patients.
  
  
  METHODS
  Since November 2009, we performed 20 robot-assisted living-donor nephrectomies. Eight patients underwent hand-assisted robotic nephrectomy, whereas 20, totally robotic nephrectomy.
  
  
  RESULTS
  Median intraoperative bleeding was 174 mL (range, 10-750) but no patient needed intraoperative transfusion with blood cells. The median warm ischemia time was 3.16 minutes (range, 0.30-6.5). there was no case of conversion to an open procedure. The median operative time was 311 minutes (range, 85-530); the median console time was 160 minutes (range, 135-220).
  
  
  CONCLUSIONS
  Robot-assisted living-donor kidney recovery was a safe and effective procedure. The totally robotic recovery is an evolving technique. The prospect of robotic staplers, endowrist ligature, and robotic single port may further increase these advantages.
authors.affiliation: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy. Electronic address: ale.giacomoni@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Giacomoni
authors.forename: S
authors.initials: S
authors.lastname: Di Sandro
authors.forename: A
authors.initials: A
authors.lastname: Lauterio
authors.forename: I
authors.initials: I
authors.lastname: Mangoni
authors.forename: P
authors.initials: P
authors.lastname: Mihaylov
authors.forename: G
authors.initials: G
authors.lastname: Concone
authors.forename: M
authors.initials: M
authors.lastname: Tripepi
authors.forename: C
authors.initials: C
authors.lastname: Poli
authors.forename: C
authors.initials: C
authors.lastname: Cusumano
authors.forename: L
authors.initials: L
authors.lastname: De Carlis
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D012371:Robotics