Introduction:Robot assisted donor nephrectomy has been used an advancement to standard laparoscopic techniques. However, limitations in available instrumentation reduce the efficiency of the procedure especially at the point of vascular stapling and kidney extraction. It is usually necessary to undock the robot and convert to less agile standard laparoscopic instrumentation in order to safely ligate and extract the donor vessels. This can add significantly to the operative time as well as loss of exposure and maneuverability. The availability of new robotic stapling devices abrogates this limitation as the stapler is incorporated directly into the robotic arms allowing for better exposure and precision. Consequently, the operating surgeon is able to use the robotic instruments for the entire procedure.

Methods: This is a retrospective study of 42 living kidney donors undergoing robotic donor nephrectomies between 2014-2017.. In order to minimize inter-operator variability, all studied procedures were performed by a single surgeon. In addition, patient variables were controlled by comparing only female donors donating left kidneys with single renal arteries. There were 28 donors in the control group who underwent standard robotic nephrectomy. The 14 donors in the study arm used the Da Vinci 30mm curved tip endowrist robotic vascular stapler(RVS) for vessel ligation. Operative time, as defined by procedure start to arterial cross-clamping, was significantly shorter in the RVS group. There were no conversions to open nephrectomy in either group. There was no difference in estimated blood loss(EBL) and no difference in post-operative length of stay between groups. Table 1

Conclusion: The use of the robotic stapler(RVS) eliminates the need to undock the robotic system and convert to a standard laparoscopic setup for the crucial step of vascular stapling and kidney extraction. Operative time to cross-clamping is reduced with no significant intra-operative complications. Our initial experience demonstrates the safety and efficiency of the newly introduced endowrist robotic stapling device in living donor minimally invasive nephrectomy.

CITATION INFORMATION: Tan M., Pollinger H. An Initial Experience with the Endowrist Robotic Endostapling Device for Renal Donor Nephrectomy Am J Transplant. 2017;17 (suppl 3).

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