Robotic-assisted single-port donor nephrectomy using the da Vinci single-site platform

Background: Although single-port donor nephrectomy offers improved cosmetic outcomes, technical challenges have limited its application to selected centers. Our center has performed over 400 single-port donor nephrectomies. The da Vinci single-site robotic platform was utilized in an effort to overcome the steric, visualization, ergonomic, and other technical limitations associated with the single-port approach. Materials and methods: Food and Drug Administration device exemption was obtained. Selection criteria for kidney donation included body mass index <35, left kidney donors, and <= 2 renal arteries. After colonic mobilization using standard single-port techniques, the robotic approach was utilized for ureteral complex and hilar dissection. Results: Three cases were performed using the robotic single-site platform. Average total operative time was 262 +/- 42 min including 82 +/- 16 min of robotic use. Docking time took 20 +/- 10 min. Blood loss averaged 77 +/- 64 mL. No intraoperative complications occurred, and all procedures were completed with our standard laparoscopic single-port approach. Conclusions: This is the first clinical experience of robotic-assisted donor nephrectomy utilizing the da Vinci single-site platform. Our experience supported the safety of this approach but found that the technology added cost and complexity without tangible benefit. Development of articulating instruments, energy, and stapling devices will be necessary for increased application of robotic single-site surgery for donor nephrectomy. (C) 2017 Elsevier Inc. All rights reserved.