Christou CD, Antoniadis S, Majumder A, Zakri R, Olsburgh J, Callaghan C, Papadakis G, Sran K, Drage M, Decaestecker K, Challacombe B, Kessaris N, Loukopoulos I. Robot-assisted vs hand-assisted laparoscopic donor nephrectomy in the United Kingdom: Equivalent outcomes in the first national series. World J Transplant 2026; 16(1): 113075 [DOI: 10.5500/wjt.v16.i1.113075]
Corresponding Author of This Article
Ioannis Loukopoulos, MD, Consultant, Department of Renal Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom. i.loukopoulos@nhs.net
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 18, 2026 (publication date) through Jan 14, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Transplantation
ISSN
2220-3230
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Christou CD, Antoniadis S, Majumder A, Zakri R, Olsburgh J, Callaghan C, Papadakis G, Sran K, Drage M, Decaestecker K, Challacombe B, Kessaris N, Loukopoulos I. Robot-assisted vs hand-assisted laparoscopic donor nephrectomy in the United Kingdom: Equivalent outcomes in the first national series. World J Transplant 2026; 16(1): 113075 [DOI: 10.5500/wjt.v16.i1.113075]
World J Transplant. Mar 18, 2026; 16(1): 113075 Published online Mar 18, 2026. doi: 10.5500/wjt.v16.i1.113075
Robot-assisted vs hand-assisted laparoscopic donor nephrectomy in the United Kingdom: Equivalent outcomes in the first national series
Chrysanthos D Christou, Savvas Antoniadis, Avishek Majumder, Rhana Zakri, Jonathon Olsburgh, Chris Callaghan, Georgios Papadakis, Kiran Sran, Martin Drage, Karel Decaestecker, Ben Challacombe, Nicos Kessaris, Ioannis Loukopoulos
Chrysanthos D Christou, Savvas Antoniadis, Avishek Majumder, Rhana Zakri, Jonathon Olsburgh, Chris Callaghan, Georgios Papadakis, Kiran Sran, Martin Drage, Nicos Kessaris, Ioannis Loukopoulos, Department of Renal Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, United Kingdom
Karel Decaestecker, Department of Urology, Ghent University Hospital, Ghent 9000, Belgium
Ben Challacombe, Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, United Kingdom
Author contributions: Christou CD contributed to data analysis, and drafted the manuscript; Christou CD, Antoniadis S, and Majumder A contributed to data collection; Loukopoulos I conceptualized the study and had the overall supervision; Christou CD, Antoniadis S, Majumder A, Zakri R, Olsburgh J, Callaghan C, Papadakis G, Sran K, Drage M, Decaestecker K, Challacombe B, Kessaris N, and Loukopoulos I reviewed and edited the final manuscript. All authors have read and approved the final manuscript.
Institutional review board statement: This study has been approved by the TRU Clinical Governance Committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Anonymized data are available from the corresponding author upon reasonable request, subject to institutional data governance policies.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ioannis Loukopoulos, MD, Consultant, Department of Renal Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom. i.loukopoulos@nhs.net
Received: August 14, 2025 Revised: September 12, 2025 Accepted: November 26, 2025 Published online: March 18, 2026 Processing time: 153 Days and 11.2 Hours
Abstract
BACKGROUND
Living donor kidney transplantation is the optimal method of long-term renal replacement therapy. Minimally invasive donor nephrectomy techniques, such as robot-assisted (RALDN) and hand-assisted (HALDN) laparoscopic procedures, are well-established in high-income countries and are being increasingly adopted worldwide. Nevertheless, no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.
AIM
To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.
METHODS
A case-control matching analysis was performed based on the following parameters: Sex, age, body mass index, procedure laterality, number of renal arteries, and previous abdominal surgeries. Key surgical outcomes, including primary warm ischemia time, operative duration, and post-operative recovery, were evaluated.
RESULTS
In this cohort of 140 living donors (70 RALDN vs 70 HALDN), donor and recipient outcomes were equivalent across key metrics: Pain scores, overall complication rates, readmissions, reoperations, and creatinine levels at 30 days and 1 year. Recipient long-term renal function did not differ between groups. Operative time for RALDN decreased significantly over the study period, indicating progressive improvement along the learning curve. Although RALDN was associated with a modestly longer mean warm ischaemia time (3.53 minutes vs 2.76 minutes, P < 0.001) and extended hospital stay (4.21 days vs 3.17 days, P < 0.001), these did not translate into any disadvantage in clinical outcomes.
CONCLUSION
In this first United Kingdom comparative cohort, RALDN demonstrated excellent safety and efficacy, even in the early phase of our programme, matching the outcomes of the well-established, gold-standard HALDN approach. Moreover, the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
Core Tip: This is the first United Kingdom study to compare robot-assisted (RALDN) and hand-assisted laparoscopic donor nephrectomy outcomes. In a matched cohort of 140 donors, both techniques achieved equivalent safety and efficacy, with no differences in donor or recipient renal function at one year. Although RALDN had longer warm ischaemia and hospital stay, outcomes improved as the surgical team advanced along the learning curve. This work demonstrates the feasibility of establishing RALDN in a high-volume United Kingdom center without prior robotic experience, providing a foundation for further integration of robotic platforms in kidney transplantation.
