Integrating robotic donor nephrectomy into contemporary living donor programmes: Evidence and practical considerations

Table 1 Comparative characteristics of hand-assisted laparoscopic donor nephrectomy vs robotic-assisted laparoscopic donor nephrectomy

Ref.	Dimension	Hand-assisted laparoscopic donor nephrectomy	Robotic-assisted laparoscopic donor nephrectomy
Roh et al[6], 2018; Kawka et al[7], 2023; Lai et al[8], 2024; Windisch et al[10], 2022; Zeuschner et al[11], 2020; Papa et al[12], 2023; Khajeh et al[13], 2023; Higgins et al[14], 2017; Dalager et al[15], 2020	Operative field	Tactile feedback; hybrid open-lap access	Magnified 3D vision; tremor-filtered precision
	Instrumentation	Limited degrees of freedom	Full articulation via wristed instruments
	Ergonomics	High physical strain on the shoulders, neck, and lumbar spine	Seated console position; reduced musculoskeletal load
	Warm ischaemia time	Often shorter due to rapid extraction	Slightly longer in early cases; clinically negligible
	Learning curve	Long, shallow, experience-dependent	Steeper but shorter; rapid efficiency once established
	Complication rates	Low and stable	Low and equivalent
	Reproducibility across surgeons	Variable; dependent on manual skill	Higher consistency due to platform stability
	Institutional cost	Low per case	Higher capital + consumable costs
	Strategic role	Baseline technique in most programmes	An adjunct technique that expands capability

3D: Three-dimensional.