*Purpose: Robotic assisted live donor nephrectomies (RDN) continue to increase in prevalence over the last years. Prior studies demonstrated outcomes of robotic procedures are no worse than laparoscopic donor nephrectomies (LDN). Our aims were to further explore the differences in outcomes between these techniques of living donor kidney transplantation as more centers shift towards the robotic approach

*Methods: This is a retrospective study comparing surgical techniques for living donor nephrectomies at a single institution. The results of 90 consecutive live donor nephrectomies performed from May 2016 to October 2021, consisting of 33 laparoscopic and 57 robotic, were reviewed. The two surgical approaches were compared by collecting information on operative time, intraoperative blood loss, intraoperative fluids administered, PRN opioids administered in hospital, length of stay, GFR and creatinine at discharge, and creatinine at 3, 6, and 12-month intervals

*Results: In both groups, operations were performed on patients with similar gender distribution (73% vs. 67% female, p=0.61), BMI (26.9 vs. 27.3, p= 0.58), and age (42.9 vs 47.9, p=0.10). Left nephrectomies were dominant in both groups, however with significantly more in the RDN group (75.4% vs. 52.1%, p=0.03). The techniques had significantly different operative length (300min vs 263min, p=0.01) and blood loss (64mL vs 155mL, p=0.008). Furthermore, the RDN group required significantly less intraoperative fluid replacement (3.08L vs 4.41L p=0.000007) and had a shorter length of hospitalization (2.44 vs. 3.42 days, p=0.008). There were no differences in morphine milligram equivalents during the post-operative period (1120 vs. 1298, p = 0.063). The RDN group had a significantly increased GFR on day 1 post-operatively (64.5 vs 57.2, p = 0.013) but not at discharge, 1-month, 3-month, 6-month, or 1-year follow-up. There were no significant differences in creatinine at discharge, 3-months, 6-months, or 12-months post-op

*Conclusions: This study has demonstrated 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 as well as shorter hospital stay may reflect decreased tissue manipulation allowed by robotic assistance. However, the novelty and learning curve of the technique along with robotic set-up may have contributed to the longer operative times seen in patients undergoing RDN

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