1. Introduction

2. Surgical Approach

3. Pfannenstiel Incision and Placement of Ports

4. Robot Docking

5. Medial Rotation of the Descending Colon

6. Identification and Dissection of the Ureter

7. Further Rotation of the Colon, Spleen, and Gerota's Fascia to Enter the Retroperitoneum and Expose the Kidney and Renal Vein

a. Divide Gonadal Vein

b. Divide Adrenal Vein

8. Follow the Renal Vein and Identify the Gonadal and Adrenal Veins

9. Identification of Renal Artery

a. Identification and Division of Lumbar Vein

10. Mobilization of the Kidney

11. Clipping and Division of Ureter

12. Robot Undocking

13. Division of Renal Artery and Vein Through Port with Handheld GIA Stapler and Removal of the Kidney

a. TAP Block

14. Donor Hemostasis and Kidney Preparation on the Back Table

15. Closure

16. Post-op Remarks

Kidney transplantation is the preferred treatment for patients with end-stage renal disease and is associated with a better quality of life and survival compared to other renal replacement therapies. Compared to deceased donor kidneys, living donor kidney donation is associated with shorter wait times, improved patient and graft survival, and the possibility of preemptive transplantation. After the initial learning curve, robotic assisted living donor nephrectomy has similar outcomes compared to open and laparoscopic nephrectomy, and in some settings an overall decreased length of stay. In this article, we present a case of a robotic-assisted living donor nephrectomy, including evaluation, technique, and considerations for the surgeon preoperatively and intraoperatively.

Watch this full-length, narrated surgical video of a robotic-assisted laparoscopic left donor nephrectomy for living kidney donation performed by Dr. Leigh Anne Dageforde at Massachusetts General Hospital.

Massachusetts General Hospital