From Lumbotomy to Robotic surgery: Narrative review of comparative studies of Surgical techniques in living donor nephrectomy

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Abstract
Living donor nephrectomy (LDN) is a cornerstone of renal transplantation, enabling transplantation in patients with end-stage renal disease (ESRD) without the pain of being on a waiting list. Surgical techniques for living donor nephrectomy have evolved from open donor nephrectomy (ODN) to minimally invasive approaches, including laparoscopic donor nephrectomy (LDN), hand-assisted laparoscopic donor nephrectomy (HALDN), and robot-assisted donor nephrectomy (RADN). This review evaluated and compared the outcomes of these techniques across five categories: donor outcomes, recipient graft outcomes, perioperative metrics, cost and accessibility, and long-term donor satisfaction. Current evidence supports a shift toward minimally invasive methods as the gold standard, with laparoscopic techniques demonstrating superior donor recovery profiles and equivalent graft outcomes compared to open surgery. However, emerging techniques such as RADN require further research owing to cost and learning curve limitations.

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