*Purpose: Robotic donor nephrectomy (RLDN) is an emerging procedure of choice for living kidney donors at many programs. This approach has benefit of minimal invasive surgery as well improved ergonomic movements for the surgeon, 6-degrees of freedom, precision and 3-D vision.  The purpose of this study was to evaluate the technical feasibility and safety of non-hand assisted robotic donor nephrectomy in living donors and assess our outcomes. 

*Methods: Retrospective review was conducted in patients who underwent RLDN from 02/2016 to 12/2019 at our center. All relevant demographic and perioperative data was collected. Postoperative course including renal function before surgery and 2 weeks post-surgery, with all complications and additional long-term follow up were evaluated. 

*Results: A total of 141 donor robotic nephrectomies were performed at our center during study period. Majority of them were females (65%) with median age of 43 years(range 18-71 years). Thirty-nine donors underwent right donation and 102 had left kidney donation based on their vascular anatomy and size. Median operative time was 191 minutes(123-334 minutes). Multiple arteries and veins noted in 26 and 19 patients respectively. Average estimated blood loss was 37 cc. No donor required any blood transfusion. Predonation average creatinine was 0.83mg/dl and at 2 weeks 1.29mg/dl. Median hospital stay was 2 days (2-5 days). Nausea was most common complication(21%). Three patients had chest pain and two patients hypertension in early postoperative period. One patient had gluteal muscle rhabdomyolysis managed conservatively. Three donors had arterial stump bleeding after stapling. None required conversion to open procedure. Two patients required readmission, one for severe constipation with abdominal pain and another had a pneumonia. No donor had Clavien-Dindo 3 or higher complication.

*Conclusions: RDLN is safe procedure with excellent outcome. The application of robotic technique to donor nephrectomy allows for greater control and maneuverability allowing it to be a safe and attractive option for both patients and surgeons.

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