*Purpose: Living donor kidney transplants represent nearly 25% of all kidney transplants performed in the United States. Over the last 10 years, an increasing emphasis has been placed on minimally invasive donor nephrectomy procedures, particularly with the advent of robotic techniques. We assessed the initial experience at our institution with robotic donor nephrectomies regarding operative factors and patient outcomes.

*Methods: From February 2020 to May 2021, we completed the first fifty robotic donor nephrectomies at our institution. A retrospective review was conducted in comparison to fifty laparoscopic donor nephrectomies performed by the same surgeons just prior to introduction of the robotic approach. Patient characteristics and operative variables were extracted from the medical record. Descriptive statistics were used in data analysis.

*Results: No significant differences were noted in donor patient demographics or kidney anatomic characteristics between the robotic and laparoscopic groups. Mean operative time (187 vs. 139 min, p<0.01) and cross-clamp to on-ice time (4.3 vs. 2.0 min, p<0.01) were significantly longer in the robotic group. Length of stay was comparable (1.7 vs. 1.8 days), and postoperative complications were rare in both groups. Kidney recipients of robotic vs. laparoscopic donors also demonstrated no significant differences in length of stay (3.3 vs. 3.7 days) or rates of delayed graft function (4% vs 2%).

*Conclusions: Robotic living donor nephrectomy offers a promising alternative minimally invasive approach with excellent patient outcomes. Additional assessment regarding surgeon ergonomics, perceptions of operative efficiency, and trainee education is ongoing as our institutional knowledge continues to expand.

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