A survey among surgeon-members of the American Society of Transplant Surgeons (ASTS) however, also revealed that multiple locking clips are still commonly used in laparoscopic cases of living kidney donation ( 10, 11).įrom a technical perspective robotic assisted surgery provides the surgeon with enhanced 3D visualization of the operative field and the use of wristed instrumentation allows tremor free articulation with seven degrees of freedom. In general, transfixing techniques using various vascular stapling devices and surgical sutures are considered superior when compared with non-transfixing techniques like clips and ligatures. Opinions about the safety of specific techniques of renal vascular closure are heterogeneous and predominantly investigated in open and laparoscopic procedures of living kidney donation. Hemorrhagic complications resulting from inadequate renal artery closure in living kidney donation surgery have been shown to jeopardize donor life and health. Minimization of any potential risk factors thus maximizing donor safety is even more highest priority ( 9). Unlike in other surgical interventions, living kidney donation involves healthy altruistic individuals, who are willing to undergo major surgery for the wellbeing of another human being. In this context, robotic assisted nephrectomy for living kidney donation has become a well-established procedure, competing for supremacy with laparoscopic and hand assisted minimally invasive approaches ( 7, 8). This evolution was fueled by the fact that minimally invasive operative techniques generate significant patients’ benefits such as reduction in postoperative pain, decreased length of hospital stay, better cosmetic results and lower morbidity rates ( 4- 6). Minimally invasive surgical techniques have substantially contributed to the future development of transplant programs and among others significantly increased the number of potential living donors ( 2, 3). Nephrectomy for living kidney donation has been performed laparoscopically for more than two decades ( 1).

The First Incision by Justine Sebastian