Robotic-assisted living donor nephrectomy in open kidney transplantation: Our clinical experience

Robotic-assisted living donor nephrectomy (RALDN) has been shown to be a safe and feasible option, offering enhanced visualization and improved surgical dexterity, allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants, even in cases of grafts with anatomical variants. We report our recent experience in using RALDN for open kidney transplantation (OKT). Between August 2021 and July 2025, 122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute. Clinical outcomes, during the first 12 months post-transplant, including the incidence of delayed graft function (DGF), surgical complications, estimated glomerular filtration rate (eGFR), and graft loss, were evaluated. Sixteen pediatric and 106 adult recipients were included. The median recipient and donor ages were 42.2 yr and 39.5 yr, respectively. Male recipients comprised 63.1% (77/122); female donors comprised 56.6% (69/122). Among the donors, no conversion to open surgery was needed, and no post-operative complications attributed to the RALDN procedure were observed. Thirty-one kidney grafts required back-table reconstruction. The median cold and warm ischemia times were 55.5 min and 27.0 min, respectively. One case (0.8%) of DGF was observed. One recipient (0.8%) developed a post-operative vascular complication; five (4.1%) developed a urologic complication. The median eGFRs at 1 mo, 3 mo, 6 mo, and 12 mo post-transplant were 71.9, 77.1, 75.1, and 72.1 mL/min/1.73m 2 , respectively. No cases of graft failure during the first 12 months post-transplant were observed, and one patient died with a functioning graft. RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients. This minimally invasive approach should be offered as a safe alternative to living donor patients.