*Purpose: Three dimensional visualization, improved dexterity and fine instrument control make robotic surgery an attractive option for further improving the safety profile of laparoscopic living donor nephrectomy (LDN). This is a single center review of the initial experience of a high volume kidney transplant program in transitioning from laparoscopic to robotic donor nephrectomy (RDN).

*Methods: Retrospective review of prospectively maintained living donor nephrectomy database at Washington University in St Louis. RDN was implemented in 2020 after 3 months of program building. Donor and recipient data for the first 30 RDNs was reviewed and compared with the last 30 LDNs to assess learning curve and safety profile.

*Results: The mean age of patients undergoing RDN was 47 years, the majority were female (72%) and the average BMI was 27. Ninety-three percent had left sided nephrectomy and one-third had more than one artery or vein. The total operative time (TOT) was 194 minutes with console time of 128 minutes. There were no conversions to laparoscopic or open surgery. Estimated blood loss was 62 ccs, and median length of stay (LOS) was 2 days. Significant complication (Clavien-Dindo III-IV) was seen in one patient (pneumothorax). There were no complications in recipients related to donor surgery technique. There was no difference between the RDN and LDN studied variables except for TOT and the warm ischemia time (WIT), defined as cross clamp to on ice time, which were significantly longer for RDN groups (194 mins vs. 136 mins and 5 mins vs. 2 mins, respectively). All kidneys were transplanted successfully with no difference in delayed function and graft survival rates between the two groups.

*Conclusions: RDN is a viable alternate to LDN and can be safely implemented after careful planning and team building with comparable donor and recipient outcomes. Improved visualization and ergonomic ease offer potential advantages over LDN.

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