Robotic nephrectomy for living donation: surgical technique and literature systematic review.
BACKGROUND
As compared with traditional laparoscopy, robotic-assisted surgery provides better EndoWrist instruments and three-dimensional visualization of the operative field. Studies published so far indicate that living donor nephrectomy using the robot-assisted technique is safe, feasible, and provides remarkable advantages for the patients.


METHODS
From 5 papers reporting detailed descriptions of surgical technique for robotic assisted nephrectomy (RAN) in living donor kidney transplantation, we have gathered information about the surgical techniques as well as about patients' intra- and postoperative outcome. Data from these articles were analyzed together with the data from our own experience (33 cases) so that the total number of analyzed cases was 292.


RESULTS
In the analyzed populations, no case of donor death occurred, and no case developed complication above grade 2 of Clavien score. Perioperative complications occurred in 37 of the 292 patients (12.6%). Accidental acute hemorrhage occurred in 5 of the 292 cases (1.7%). The average overall intraoperative blood loss was 67.8 mL (range 10 to 1,500). The average warm ischemia time was 3.5 minutes (range .58 to 7.6). Conversion to the open technique occurred in only 4 cases (1.3%). The average overall operative time was 192 minutes (range 60 to 400). The average length of the hospital stay was 2.7 days (range 1 to 10).


CONCLUSIONS
Safety and feasibility of RAN are pointed out in all the reviewed article, both as hand-assisted and as totally robotic technique. RAN appears to be significantly easier for the surgeons and the results are comparable with the ones obtained with the pure laparoscopic technique.
Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Alessandro
A
Giacomoni
Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Surgical Sciences, University of Pavia, Pavia, Italy; Department of Experimental Medicine, University of Pavia, Pavia, Italy. Electronic address: stefano.disandro@ospedaleniguarda.it.
Stefano
S
Di Sandro
Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Andrea
A
Lauterio
Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Surgical Sciences, University of Pavia, Pavia, Italy.
Giacomo
G
Concone
Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Surgical Sciences, University of Pavia, Pavia, Italy.
Vincenzo
V
Buscemi
Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Ornella
O
Rossetti
Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Luciano
L
De Carlis
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D061214:Patient Safety; D065287:Robotic Surgical Procedures / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
Kidney transplantation; Living donation; Robotic-assisted nephrectomy; Systematic review