*Purpose: Our aim was to further explore the difference in results between laparoscopic and robotic assisted techniques of living donor nephrectomies

*Methods: This is a retrospective study analyzing the results of 71 consecutive live donor nephrectomies performed from May 2016 to October 2020, consisting of 33 laparoscopic and 38 robotic procedures. The two surgical approaches were compared by collecting information on operative length, intraoperative blood loss, intraoperative fluid administered, PRN opioids administered in hospital, length of stay, GFR and creatinine at discharge, and creatinine at 3, 6, and 12-month intervals

*Results: Robotic and Laparoscopic operative techniques were found to have different operative length times (297min vs 263min, p=0.03) and different blood loss (83mL vs 155mL, p=0.025). RDN required significantly less intraoperative fluid replacement than their LDN counterparts (3.18L vs 4.41L p=0.00007). RDN patients also had a significantly increased GFR on day 1 post-operatively (64.5 vs 57.2, p = 0.013) and on day of discharge (68.7 vs 60.2, p = 0.023) but not at 1-month follow-up (64.9 vs 59.3, p = 0.12). There was no statistical difference in creatinine at discharge (1.11 vs 1.38 p=0.22), 3 months post-op (1.17 vs 1.21 p=0.73), 6 months post-op (1.15 vs 1.12, p = 0.79), or 12 months post-op (1.15 vs 1.13, p = 0.60).RDN patients experienced a non-significant 20% decrease in average length of stay (2.73 vs. 3.42 days p=0.78) but also a non-significant increase in Morphine milligram equivalents administered during their stay (1530 vs. 1470 p=0.88)

*Conclusions: RDN is a safe and effective alternative surgical approach when compared to LDN. The decreases in blood loss and fluid administration and increased day 1 GFR may reflect the decreased tissue manipulation allowed for by robotic assistance. However, the novelty and learning curve of the technique may have contributed to the longer operative times seen in patients undergoing RDN

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