title: Evolution of robotic nephrectomy for living donation: from hand-assisted to totally robotic technique.
abstract: BACKGROUND
  The application of robotic-assisted surgery offers EndoWrist instruments and 3-D visualization of the operative field, which are improvements over traditional laparoscopy. The results of the few studies published so far have shown that living donor nephrectomy using the robot-assisted technique is safe, feasible, and offers advantages to patients.
  
  
  METHODS
  Since November 2009, 16 patients have undergone robotic-assisted living donor nephrectomy at our Institute. Patients were divided into two groups according to the surgical technique adopted for the procedure: Group A, hand-assisted robotic nephrectomy (eight patients); Group B, totally robotic nephrectomy (eight patients).
  
  
  RESULTS
  Intra-operative bleeding was similar in the two groups (90 vs 100 mL for Group A and B, respectively). Median warm ischemia time was significantly shorter in Group A (2.3 vs 5.1 min for Group A and B, respectively, P-value = 0.05). Switching to the open procedure was never required. Median operative time was not significantly longer in Group A than Group B (275 min vs 250 min, respectively).
  
  
  CONCLUSIONS
  Robotic assisted living kidney recovery is a safe and effective procedure. Considering the overall technical, clinical, and feasibility aspects of living kidney donation, we believe that the robotic assisted technique is the method of choice for surgeon's comfort and donors' safety.
authors.affiliation: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Sandro
authors.forename: Andrea
authors.initials: A
authors.lastname: Lauterio
authors.forename: Giacomo
authors.initials: G
authors.lastname: Concone
authors.forename: Iacopo
authors.initials: I
authors.lastname: Mangoni
authors.forename: Plamen
authors.initials: P
authors.lastname: Mihaylov
authors.forename: Matteo
authors.initials: M
authors.lastname: Tripepi
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007511:Ischemia; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011184:Postoperative Period; D065287:Robotic Surgical Procedures; D020858:Tissue and Organ Harvesting
keywords: kidney transplantation; living donation; robotic-assisted nephrectomy