Robot-assisted vs hand-assisted laparoscopic donor nephrectomy in the United Kingdom: Equivalent outcomes in the first national series

BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy. Minimally invasive donor nephrectomy techniques, such as robot-assisted (RALDN) and hand-assisted (HALDN) laparoscopic procedures, are well-established in high-income countries and are being increasingly adopted worldwide. Nevertheless, no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date. AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program. METHODS A case-control matching analysis was performed based on the following parameters: Sex, age, body mass index, procedure laterality, number of renal arteries, and previous abdominal surgeries. Key surgical outcomes, including primary warm ischemia time, operative duration, and post-operative recovery, were evaluated. RESULTS In this cohort of 140 living donors (70 RALDN vs 70 HALDN), donor and recipient outcomes were equivalent across key metrics: Pain scores, overall complication rates, readmissions, reoperations, and creatinine levels at 30 days and 1 year. Recipient long-term renal function did not differ between groups. Operative time for RALDN decreased significantly over the study period, indicating progressive improvement along the learning curve. Although RALDN was associated with a modestly longer mean warm ischaemia time (3.53 minutes vs 2.76 minutes, P < 0.001) and extended hospital stay (4.21 days vs 3.17 days, P < 0.001), these did not translate into any disadvantage in clinical outcomes. CONCLUSION In this first United Kingdom comparative cohort, RALDN demonstrated excellent safety and efficacy, even in the early phase of our programme, matching the outcomes of the well-established, gold-standard HALDN approach. Moreover, the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.