Robotic-Assisted Simultaneous Bilateral Native Nephrectomy and Living Donor Kidney Transplantation

INTRODUCTION: Simultaneous bilateral nephrectomy and living donor kidney transplantation (LDKT) is often indicated for autosomal dominant polycystic kidney disease (ADPKD) with end-stage kidney disease (ESKD). Robotic-assisted surgery offers a minimally invasive alternative to open approaches and may reduce perioperative morbidity and length of stay. METHODS: Four adults with ADPKD/ESKD underwent fully robotic-assisted simultaneous bilateral nephrectomy/LDKT (RASBN/LDKT) at a single high-volume transplant center. All procedures used an intra-abdominal approach with a Pfannenstiel incision and GelPort for native kidney extraction and allograft introduction. Clinical, perioperative, and functional outcomes were recorded prospectively and analyzed retrospectively. RESULTS: Median total operative time was 462.5 min (range, 401-544 min). Median length of stay was 3.5 days (range, 3-5 d). There were no intraoperative or postoperative vascular, urological, or surgical complications, and no conversions or hand assistance were required. All recipients had immediate graft function without delayed graft function (no hemodialysis in the first postoperative week). Kidney allograft function remained stable through 12 mo after transplant. CONCLUSIONS: Robotic-assisted simultaneous bilateral nephrectomy/LDKT is feasible and safe in carefully selected ADPKD/ESKD recipients, providing excellent early clinical outcomes and expanding the role of minimally invasive techniques for complex scenarios.