Feasibility of Simultaneous Donor Nephrectomy and Kidney Transplantation Using a Shared Single-Port Robotic Platform

Feasibility of Simultaneous Donor Nephrectomy and Kidney Transplantation Using a Shared Single-Port Robotic Platform | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility of Simultaneous Donor Nephrectomy and Kidney Transplantation Using a Shared Single-Port Robotic Platform Hafiz Umair Siddiqui, Adam Esa, Dylan Isaacson, Sami Shoucair, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9511569/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Single-port (SP) robotic platforms are enabling new approaches to living donor nephrectomy and kidney transplantation, but limited access to robotic systems may prevent simultaneous donor and recipient procedures. This retrospective cohort study evaluated the feasibility, safety, and efficiency of a simultaneous SP robotic workflow using a single robotic platform for both operations. 45 living kidney donor/recipient operations were performed between October 2019 and September 2025. 15 pairs underwent a simultaneous SP robotic approach in which both donor nephrectomy and recipient transplant were completed using the same SP robotic platform, while 30 cases underwent laparoscopic donor nephrectomy followed by SP robotic kidney transplantation. Outcomes included operative time, graft ischemia times, perioperative complications, pain scores, length of stay, and graft function. Baseline donor characteristics were similar between groups. SP robotic donor nephrectomy had longer operative time than laparoscopic nephrectomy (median 4:10 vs 3:07 hours, p=0.001), while warm ischemia time, blood loss, length of stay, and renal function were comparable. Donors in the SP group reported lower postoperative day 1 pain scores (p=0.03). In recipients, the simultaneous SP robotic approach resulted in a shorter operative time (3:54 vs 4:41 hours, p=0.015) and anastomosis time (44 vs 52.5 minutes, p=0.007), with no differences in cold ischemia time, complications, or graft function. Overall, a simultaneous SP robotic strategy using a shared platform is feasible, safe, and improves operative efficiency without compromising outcomes. Single port robotic kidney transplantation Single port donor nephrectomy RAKT Living donor Perioperative outcomes Robotic Surgery Figures Figure 1 Figure 2 Introduction Kidney transplantation continues to be a cornerstone therapy for patients with end-stage renal disease, offering superior long-term outcomes compared to maintenance dialysis [1–3]. Alongside advancements in immunosuppression and recipient care, surgical techniques in both donor nephrectomy and recipient transplantation have undergone significant refinement [4–9]. Living donor nephrectomy occupies a unique ethical and clinical space as it involves operating on healthy individuals who receive no direct medical benefit. As such, minimizing donor morbidity through minimally invasive techniques and optimizing recovery has become a major focus in transplant surgery [10–14]. Similarly, the recipient operation has also advanced with the increasing adoption of minimally-invasive and robot-assisted approaches [15–19]. The introduction of the single-port (SP) robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) represents a significant step forward, offering the potential for fewer incisions, improved cosmesis, and enhanced recovery for both donors and recipients [6,9,19,20]. Ideally, both the donor and recipient should benefit from the advantages offered by robotic platforms. While having two individual robots would allow for true simultaneous surgery, this is not always feasible in most transplant centers due to limited robotic access and increased cost [21–22]. As such, developing a safe and efficient workflow that enables both patients to benefit from a shared robotic system is both a practical innovation and a step toward optimizing care within existing resource constraints. In this study, we present our experience with the first 15 consecutive kidney donor/recipient pairs performed using a single SP platform. We aim to evaluate the feasibility, safety, and reproducibility of simultaneous SP robotic nephrectomy and transplantation, while also highlighting the intraoperative logistics, perioperative outcomes, and technical considerations that may occur. Methods Study Design and Setting This was a retrospective cohort study of living donor kidney transplants performed between October 2019 and September 2025 in which the recipient procedure was performed using the SP approach, either as part of a simultaneous workflow or as an isolated SP transplant. In the simultaneous SP cohort, donor nephrectomies were performed using the SP platform, whereas in the comparator cohort, donor nephrectomies were performed using a pure laparoscopic approach. Donor and recipient outcomes were analyzed separately. For the donor analysis, 15 SP donor nephrectomies were compared with 30 laparoscopic donor nephrectomies performed during the same period. For recipient analysis, 15 simultaneous SP kidney transplants were compared with 30 isolated SP kidney transplants (Figure 1) Surgical Technique The overall workflow, including donor and recipient procedures and robotic transition, is illustrated in Online Resource 1 In simultaneous SP transplantation, both donor nephrectomy and recipient procedures are performed using the SP robotic platform. Procedures are conducted in adjacent operating rooms, with the donor surgery initiated first. In the recipient operating room, the patient is brought in approximately 30-45 minutes prior to kidney extraction. Anesthesia is induced, and the patient is prepped and draped. A midline or Pfannenstiel incision is performed, followed by blunt development of the extraperitoneal space and SP port placement. After kidney extraction, the graft undergoes back-table preparation per our robotic protocol (typically 20–40 minutes). During this interval, the donor is closed, and the robotic system is relocated and docked in the recipient's operating room, allowing the transplant to proceed using the same SP platform. A schematic of the operating room setup and robotic transition is shown in Figure 2. In the isolated SP group, donor and recipient procedures were performed independently. The recipient was typically brought into the operating room approximately 1 hour prior to kidney extraction. Following donor nephrectomy and back table preparation, the graft was transferred to a separate operating room where the SP robot had already been docked for vessel bed preparation and the subsequent transplant operation. Data Collection Demographic, clinical, and perioperative variables were retrospectively collected from the electronic medical record. These included donor and recipient age, sex, body mass index (BMI), preoperative creatinine, dialysis status, and history of prior abdominal surgery, as well as operative metrics. Renal function in donors and graft function in recipients was assessed using serum creatinine. In donors, creatinine was recorded at discharge, 2 weeks, and 1 month postoperatively. In recipients, creatinine was recorded at discharge and 3 months post-transplant. Delayed graft function (DGF) was defined as any dialysis within the first postoperative week. Key surgical parameters, including warm ischemia time (WIT), cold ischemia time (CIT), anastomosis time, and total operative time, were recorded. Total operative time was defined as the interval from skin incision to skin closure. Postoperative pain was assessed using the visual analog scale (VAS). Statistical Analysis Baseline demographic and clinical characteristics were compared between donor groups (SP donor nephrectomy vs laparoscopic donor nephrectomy) and recipient groups (simultaneous SP vs isolated SP kidney transplantation). Continuous variables were expressed as medians (interquartile range [IQR]) and compared using the Mann–Whitney U test. Categorical variables were compared using the chi-square or Fisher’s exact test, as appropriate. All analyses were performed using JASP (version 0.19.3; Amsterdam, Netherlands) and R (version 4.5.2; R Foundation for Statistical Computing, Vienna, Austria). A two-sided p-value <0.05 was considered statistically significant. Results A total of 45 living donor kidney transplants were analyzed: 15 simultaneous SP donor–recipient cases and 30 cases with laparoscopic donor nephrectomy followed by isolated SP kidney transplantation. Donor Characteristics and Outcomes Donor characteristics and outcomes are summarized in Table 1. Baseline characteristics were comparable between groups. The median donor age was 44 years (IQR 38.5–53.8) in the SP donor nephrectomy group and 49 years (IQR 38–60.5) in the laparoscopic donor nephrectomy group (p=0.56). Female donors comprised 66.6% and 90% of groups, respectively (p=0.06). Median BMI (29.5 vs 27.4 kg/m², p=0.20) and preoperative creatinine (0.87 vs 0.86 mg/dL, p=0.87) were similar. Median operative time was longer in the SP donor nephrectomy group (4 hours 10 minutes [IQR 4:02–4:19] vs 3 hours 7 minutes [IQR 2:49–3:29], p=0.001). The proportion of left donor nephrectomy was similar (93.3% in both groups, p=1.00). Median warm ischemia time was 3 minutes in both groups (p=0.70), and estimated blood loss was 50 mL in both groups, p=0.40. Postoperative pain scores were lower in the SP group on postoperative day 1 (median 6 [IQR 5.5–7] vs 7 [IQR 6.25–8], p=0.03), with no difference on day 2 (p=0.06). Length of stay was similar between groups (median 2 days in both groups, p=0.56). Donor renal function was comparable at discharge, 2 weeks, and 1 month. One patient (6.6%) in the SP group developed a wound infection, while none occurred in the laparoscopic group (p=0.15). Thirty-day readmission occurred in one patient (6.6%) in the SP group and none in the laparoscopic group (p=0.15). Recipient Characteristics and Outcomes Recipient characteristics and outcomes are summarized in Table 2. Baseline characteristics were comparable between groups. The median age was 42.8 years (IQR 32.6–58.1) in the simultaneous SP group and 50.6 years (IQR 47.6–59.9) in the isolated SP group (p=0.11). Median BMI (30.3 vs 31.4 kg/m², p=0.40), rate of pre-emptive transplantation (46.6% vs 53.3%, p=0.67), and prior abdominal surgery (27% vs 43.3%, p=0.27) were similar. The simultaneous SP approach was associated with shorter operative time (3 hours 54 minutes [IQR 3:21–4:22] vs 4 hours 41 minutes [IQR 3:51–5:31], p=0.015) and shorter anastomosis time (44 [IQR 39–45] vs 52.5 [IQR 45.5–65] minutes, p=0.007). Cold ischemia time (1 hour 31 minutes [IQR 1:28–1:43] vs 1 hour 34 minutes [IQR 1:13–2:15], p=0.82) and estimated blood loss (50 mL in both groups, p=0.57) were comparable. Conversion to open surgery occurred in one patient (3.3%) in the isolated SP group and none in the simultaneous SP group (p=0.49). Postoperative outcomes were similar. The median length of stay was 2 days in both groups (p=0.63), and transfusion rates were comparable (6.6% vs 13.3%, p=0.52). Pain scores were similar between groups on postoperative day 1 (p=0.09) and day 2 (p=0.97). Graft function was comparable between groups. Median creatinine at discharge was 1.87 mg/dL vs 2.54 mg/dL (p=0.06), with similar values at 3 months (1.40 vs 1.48 mg/dL, p=0.15). DGF occurred in two patients (6.7%) in the isolated SP group and none in the simultaneous SP group (p=0.37). Thirty-day readmission occurred in 6 recipients (40%) in the simultaneous SP group and 8 patients (26.6%) in the isolated SP group (p=0.28). Hematoma occurred in one patient (3.3%) in the isolated SP group, while symptomatic lymphocele occurred in one patient in each group (p=0.71). Discussion Kidney transplantation has undergone significant evolution over the past decade, with advances in surgical technology contributing to safer procedures, faster recovery, and improved patient outcomes [10-12, 16-18, 23]. The adoption of robotic platforms has emerged as an evolving development in kidney transplantation. The introduction of the SP robotic system enabled an extraperitoneal approach for recipient surgery, allowing patients to remain in the supine position and thereby avoiding the hemodynamic alterations associated with pneumoperitoneum and Trendelenburg positioning. Additionally, the SP platform facilitates donor surgery through a single transumbilical incision, potentially reducing morbidity. Our institution was among the first to pioneer SP robotic kidney transplantation in 2019, establishing the feasibility of this approach in the recipient population [9]. Building on this progress, Garden et al. [6] reported their initial experience with SP robotic donor nephrectomy in 2021, demonstrating the technical feasibility and cosmetic advantages of using an SP approach for healthy donors. This momentum has prompted broader exploration into how the SP platform can be applied across transplant surgery. Implementing the SP platform for both donor nephrectomy and kidney transplantation remains challenging, particularly due to cost and availability of robotic systems [21, 22]. Most centers have access to only one SP robot, making it difficult to coordinate both procedures in close succession. This requires intraoperative planning to prevent delays that could prolong anesthesia or cold ischemia time, both associated with worse graft outcomes [24,25]. Successful implementation depends on close team coordination, efficient OR transitions, and precise robotic management; without an integrated workflow, sharing a single robot for two complex procedures may undermine efficiency and the benefits of minimally invasive surgery. Especially for kidney transplant donors, who are healthy individuals undergoing elective surgery, minimizing surgical morbidity and maximizing cosmetic outcomes is important. Laparoscopic donor nephrectomy is currently considered the gold standard approach. Compared with open donor nephrectomy, it provides equivalent renal outcomes while offering improved postoperative recovery [5-7]. Prior studies have shown that minimally invasive surgery for donors has increased the donation rates among kidney transplant donors [26]. The SP approach offers distinct advantages over traditional laparoscopic donor nephrectomy, which typically requires multiple trocar incisions in addition to the extraction site. In contrast, SP procedures are performed through a single, concealed umbilical incision, enhancing cosmetic outcomes, and potentially improving donor satisfaction and recovery [27]. In our donor cohort, SP donor nephrectomy was associated with a longer operative time compared to laparoscopic approach. This can be explained by the expected learning curve associated with the adoption of a new technique. Importantly, despite the increased operative duration, warm ischemia time remained comparable between groups, suggesting that graft retrieval efficiency was not compromised. Furthermore, postoperative pain scores were significantly lower on postoperative day 1 in the SP group, indicating a potential early recovery benefit. Our findings are consistent with Palese et al. [28] who reported the largest SP donor nephrectomy series to date and demonstrated reduced postoperative opioid requirements with similar pain scores and comparable perioperative outcomes between SP and laparoscopic donor nephrectomy. From an operational standpoint, the choreography of this simultaneous approach represents a novel application of surgical logistics. The natural delay between donor kidney extraction, closure of the donor and graft implantation—typically used for bench preparation of the graft—creates a critical 30 to 40 minute window [29]. Within this period, the SP robot can be undocked from the donor room, transferred, re-draped and re-docked in the recipient room, allowing the transplant procedure to begin promptly. Our data demonstrates that recipient operative and anastomosis times were shorter in the simultaneous SP group. This likely reflects improved operating room efficiency and a streamlined workflow enabled by the coordinated simultaneous approach. In the simultaneous SP group, recipient induction was deliberately timed approximately 30–45 minutes prior to kidney extraction and was often delayed until the robotic platform became available for transfer to the recipient OR, potentially minimizing idle operative time. Another contributing factor may be increasing institutional experience with the SP platform. By the time the simultaneous cases were performed, the surgical team had likely surpassed the initial learning curve associated with SP kidney transplantation. Improved familiarity with instrumentation, patient positioning, and docking may therefore have contributed to reduced operative duration. Successful implementation of this workflow requires more than access to robotic technology; it depends on a well-trained and coordinated multidisciplinary team. Technical and logistical challenges remain important considerations, as robot relocation must be performed efficiently, typically during graft preparation, to avoid operative downtime. Our experience highlights several important considerations and potential applications. Notably, the same simultaneous approach could be adapted to the da Vinci Xi platform, offering a novel strategy to provide both donors and recipients with access to robotic surgery using a single robotic system. This concept may be particularly valuable for transplant centers with limited access to robotic platforms, as it could broaden the integration of robotic technology into both donor and recipient procedures. Additionally, this approach has implications for cost-effectiveness. By maximizing the use of a one robot across two procedures, institutions may achieve improved resource utilization and potentially reduce the cost per case [21-22]. Although our study was not powered to detect statistical significance across all outcome measures, the observed trends in operative efficiency and early clinical outcomes are encouraging. One open conversion occurred in the isolated SP cohort, otherwise no major intraoperative complications or conversions were noted. Donor and recipient lengths of stay and discharge creatinine levels were comparable. Importantly, this approach was logistically sustainable across fifteen consecutive cases, supporting its reproducibility and potential applicability in other high-volume centers. This study is limited by its retrospective design and relatively small sample size, particularly in the simultaneous SP group, which may reduce statistical power. As a single-center experience from a high-volume robotic transplant program, the findings may not be generalizable to centers with different expertise or resources. Additionally, the simultaneous approach requires specific institutional logistics, including access to adjacent operating rooms and coordinated workflows, which may limit broader applicability. Finally, long-term outcomes and cost-effectiveness were not assessed and warrant further study. Conclusion This study demonstrates that a coordinated, simultaneous SP robotic approach for living donor nephrectomy and kidney transplantation is feasible, safe, and reproducible using a single SP platform. With appropriate planning, experienced teams, and optimized workflow, this strategy enables efficient utilization of robotic resources without compromising perioperative or transplant outcomes. Notably, this approach was associated with improved operative efficiency, reflected by shorter recipient operative times. It offers a practical solution for centers with limited access to multiple robotic systems and has the potential to enhance operating room efficiency. Further multicenter studies are warranted to validate these findings, assess long-term outcomes, and define the broader applicability of this model. Statements and Declarations Competing interests The authors declare no competing interests. Ethical Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Cleveland Clinic Human Research Ethics Committee. Consent to participate Not applicable. Consent to publish Not applicable. Funding: None Author contributions: All authors contributed to the study conception and design. Hafiz Umair Siddiqui and Mohamed Eltemamy conceptualized the study. Material preparation, data collection and analysis were performed by Hafiz Umair Siddiqui, Adam Esa, Dylan Isaacson and Sami Shoucair. Mohamed Eltemamy, Alvin Wee, Yi-Chia Lin performed the robotic procedure. Venkatesh Krishnamurthi, Jihad Kaouk and Mohamed Eltemamy contributed to technical description. The first draft of the manuscript was written by Hafiz Umair Siddiqui and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data availability The data that support the findings of this study are available from the corresponding author, M.E, upon reasonable request. References Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New England journal of medicine. 1999 Dec 2;341(23):1725-30. Schnuelle P, Lorenz D, Trede M, Van Der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol. 1998 Nov;9(11):2135-41. doi: 10.1681/ASN.V9112135. PMID: 9808102. Port FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. 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Tables Table 1: Donor Outcomes: Simultaneous Single-Port vs. Laparoscopic Donor Nephrectomy Donor Data SP Donor Nephrectomy (n=15) Laparoscopic Donor Nephrectomy (n=30) P Value Age (year, median, IQR 44 (38.5-53.8) 49 (38-60.5) 0.56 Gender Female ( n, %) 10 (66.6%) 27 (90%) 0.06 BMI (kg/m 2 , median, IQR) 29.5 (27-32.9) 27.4 (24.5-31.5) 0.20 Preoperative creatinine (mg/dL, median, IQR) 0.87(0.78-0.96) 0.86 (0.76-0.94) 0.87 Total Nephrectomy time ( hh:min , median, IQR) 04:10 (04:02-04:19) 03:07 (02:49-03:29) 0.001 Left Kidney used (n, %) 14 (93.3%) 28 (93.3%) 1.00 Warm Ischemia (minutes, median, IQR) 3 (3-4) 3 (2-4) 0.70 Estimated blood loss (mL , median, IQR) 50 (32-50) 50 (25-50) 0.40 Postoperative Pain Score ( median, IQR) Day 1 Day 2 6 (5.5-7) 4 (3-6) 7 (6.25-8) 5 (4.5-7.25) 0.03 0.06 Creatinine at discharge (mg/dL, median, IQR) 1.26 (1.04-1.36) 1.28 (1.15-1.36) 0.46 Length of Stay (days, median, IQR) 2 (1-2) 2 (1.25-2) 0.56 Creatinine at 2 weeks ( mg/dL, median, IQR) 1.16 (1.01-1.27) 1.19 (1.06-1.34) 0.10 Creatinine at 1 month ( mg/dL, median, IQR ) 1.05 (1.01-1.11) 1.01 (0.75-1.05) 0.43 Wound infection (n, % ) 1 (6.66%) 0 (0%) 0.15 30-day Readmission (n, % ) 1 (6.6%) 0 (0%) 0.15 Table 2: Recipient Outcomes: Simultaneous vs. Isolated Single Port Kidney Transplantation Recipient Data Simultaneous SP Transplant (n=15) Isolated SP Transplant (n=30) P Value Demographics Age (year, median, IQR) 42.8 (32.6-58.1) 50.6 (47.6-59.9) 0.11 Gender Female (n, %) 5 (33%) 11 (36%) 0.82 BMI ( kg/m 2 , median, IQR) 30.3 (25.7-33.4) 31.4 (28.5-33.9) 0.40 Pre-Emptive (n, %) 7 (46.6%) 16 (53.3%) 0.67 Cause of ESRD (n, %) DM / HTN ADPKD FSGS IgA nephropathy Other 8 (53.3%) 0 (0%) 1 (6.7%) 2 (13.3%) 4 (26.7) 9 (30%) 6 (20%) 5 (16.6) 2 (6.67%) 8 (26.6%) 0.43 Previous abdominal surgeries (n, %) 4 (27%) 13 (43.3%) 0.27 Operative Data Total Operative time ( hh:min , median, IQR) 03:54 (03:21-04:22) 04:41 (03:51-5:31) 0.015 Anastomosis time (minutes, median, IQR) 44 (39-45) 52.5 (45.5-65) 0.007 Cold Ischemia ( hh:min , median, IQR) 01:31 (01:28-01:43) 01:34 (01:13-02:15) 0.82 Estimated blood loss (mL , median, IQR) 50 (50-62.5) 50 (28.5-100) 0.57 Conversion to open (n, %) 0 (0%) 1 (3.3%) 0.49 Post Operative Outcomes Length of Stay (days, median, IQR) 2 (2-3) 2 (2-3) 0.63 Blood Transfusion (n, %) 1 (6.6%) 4 (13.3%) 0.52 Postoperative Pain median (median, IQR) Day 1 Day 2 5 (3-6) 4 (2.5-5) 4.25 (3-6) 4 (3-5) 0.09 0.97 Creatinine at discharge (mg/dL, median, IQR ) 1.87 (1.55-2.33) 2.54 (1.86-3.12) 0.06 DGF (n, %) 0 (0%) 2 (6.67%) 0.37 30-day Readmission (n, %) 6 (40%) 8 (26.6%) 0.28 Lymphocele (n, %) 1 (6.6%) 1 (3.3%) 0.71 Hematoma (n, %) 0 (0%) 1 (3.3%) 0.47 Creatinine at 3 months (mg/dL, median, IQR) 1.40 (1.21-1.47) 1.48 (1.26-1.72) 0.15 Additional Declarations No competing interests reported. Supplementary Files SimultaneousSPdonorandrecipientvideo.mp4 Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 04 May, 2026 Reviews received at journal 03 May, 2026 Reviews received at journal 03 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviewers invited by journal 01 May, 2026 Editor assigned by journal 25 Apr, 2026 Submission checks completed at journal 24 Apr, 2026 First submitted to journal 23 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9511569","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634124143,"identity":"87ac0baa-855f-4575-9b80-25843c956f78","order_by":0,"name":"Hafiz Umair Siddiqui","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Hafiz","middleName":"Umair","lastName":"Siddiqui","suffix":""},{"id":634124144,"identity":"21f23278-57ff-477f-bf91-db59a0cc452a","order_by":1,"name":"Adam Esa","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"","lastName":"Esa","suffix":""},{"id":634124145,"identity":"92781331-afda-4b18-9051-c99c43340e0f","order_by":2,"name":"Dylan Isaacson","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Dylan","middleName":"","lastName":"Isaacson","suffix":""},{"id":634124151,"identity":"14711bcd-5e55-4d39-9feb-86682def1fb9","order_by":3,"name":"Sami Shoucair","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Sami","middleName":"","lastName":"Shoucair","suffix":""},{"id":634124154,"identity":"8036e82e-377b-4396-a8b8-d4b746bf21d4","order_by":4,"name":"Venkatesh Krishnamurthi","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Venkatesh","middleName":"","lastName":"Krishnamurthi","suffix":""},{"id":634124155,"identity":"e3824543-ee50-44a7-b3ba-c18cdcb3ed0c","order_by":5,"name":"Jihad Kaouk","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Jihad","middleName":"","lastName":"Kaouk","suffix":""},{"id":634124158,"identity":"87cc1651-87af-41b4-9669-9152fab9faae","order_by":6,"name":"Yi-Chia Lin","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Yi-Chia","middleName":"","lastName":"Lin","suffix":""},{"id":634124159,"identity":"73927099-a849-4d4c-8f73-90719528e7a0","order_by":7,"name":"Alvin Wee","email":"","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Alvin","middleName":"","lastName":"Wee","suffix":""},{"id":634124161,"identity":"f77d2174-6877-4382-bf2a-121863be6a33","order_by":8,"name":"Mohamed Eltemamy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYDACdgglx8DA+IBILczMYMoYyDIgTUtiA9Fa+Jn5Dz66UbMtvb/9MAPDxz21hLVINjMzG+ccu50740wyA+OMZ8cJazE4zMwmncN2O3eDBP8BZp4DxwhrsT/MzP4759/tdAMJZgbitBgwM7Mx57bdToBqqSGsReIws7F0bt9tQ5BfDs44cICwFv72xoefc77dludvP8z44MOBOsJaUADQisMkagECUm0ZBaNgFIyCkQAAug82N6OGx2gAAAAASUVORK5CYII=","orcid":"","institution":"Glickman Urological and Kidney Institute, Cleveland Clinic","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Eltemamy","suffix":""}],"badges":[],"createdAt":"2026-04-24 02:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9511569/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9511569/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109068504,"identity":"3bcc0254-dddc-4155-9c4e-03ba4d2bcfd4","added_by":"auto","created_at":"2026-05-12 10:13:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":98679,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy design and workflow of donor and recipient procedures.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiving donor–recipient pairs were stratified by donor nephrectomy approach into single-port (SP; n=15) and laparoscopic (n=30) groups. Recipient procedures were categorized as simultaneous SP kidney transplantation or isolated SP kidney transplantation.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9511569/v1/571d73fa770c314a7e24226b.png"},{"id":109068508,"identity":"92794688-5324-4648-be8b-083494384e38","added_by":"auto","created_at":"2026-05-12 10:13:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":777828,"visible":true,"origin":"","legend":"\u003cp\u003eA schematic representation of the operating room layout and robotic transition process is simultaneous SP donor-recipient procedures using the same robotic platform\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9511569/v1/e01964fcfd038076643382a0.png"},{"id":109083011,"identity":"53490587-d0b8-4f26-8a7d-f3732416847d","added_by":"auto","created_at":"2026-05-12 12:46:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1346247,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9511569/v1/a3c2df66-fafd-4650-8bad-54cdc9d16a15.pdf"},{"id":109081335,"identity":"7798f797-4f15-4809-9c1d-eb68a46f5162","added_by":"auto","created_at":"2026-05-12 12:17:02","extension":"mp4","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":962229711,"visible":true,"origin":"","legend":"","description":"","filename":"SimultaneousSPdonorandrecipientvideo.mp4","url":"https://assets-eu.researchsquare.com/files/rs-9511569/v1/bf2956d998280c08ef666352.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility of Simultaneous Donor Nephrectomy and Kidney Transplantation Using a Shared Single-Port Robotic Platform","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKidney transplantation continues to be a cornerstone therapy for patients with end-stage renal disease, offering superior long-term outcomes compared to maintenance dialysis [1–3]. Alongside advancements in immunosuppression and recipient care, surgical techniques in both donor nephrectomy and recipient transplantation have undergone significant refinement [4–9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLiving donor nephrectomy occupies a unique ethical and clinical space as it involves operating on healthy individuals who receive no direct medical benefit. As such, minimizing donor morbidity through minimally invasive techniques and optimizing recovery has become a major focus in transplant surgery [10–14]. Similarly, the recipient operation has also advanced with the increasing adoption of minimally-invasive and robot-assisted approaches [15–19].\u003c/p\u003e\n\u003cp\u003eThe introduction of the single-port (SP) robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) represents a significant step forward, offering the potential for fewer incisions, improved cosmesis, and enhanced recovery for both donors and recipients [6,9,19,20].\u003c/p\u003e\n\u003cp\u003eIdeally, both the donor and recipient should benefit from the advantages offered by robotic platforms. While having two individual robots would allow for true simultaneous surgery, this is not always feasible in most transplant centers due to limited robotic access and increased cost [21–22]. As such, developing a safe and efficient workflow that enables both patients to benefit from a shared robotic system is both a practical innovation and a step toward optimizing care within existing resource constraints.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, we present our experience with the first 15 consecutive kidney donor/recipient pairs performed using a single SP platform. We aim to evaluate the feasibility, safety, and reproducibility of simultaneous SP robotic nephrectomy and transplantation, while also highlighting the intraoperative logistics, perioperative outcomes, and technical considerations that may occur.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003e\u003cu\u003eStudy Design and Setting\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective cohort study of living donor kidney transplants performed between October 2019 and September 2025 in which the recipient procedure was performed using the SP approach, either as part of a simultaneous workflow or as an isolated SP transplant. In the simultaneous SP cohort, donor nephrectomies were performed using the SP platform, whereas in the comparator cohort, donor nephrectomies were performed using a pure laparoscopic approach.\u003c/p\u003e\n\u003cp\u003eDonor and recipient outcomes were analyzed separately. For the donor analysis, 15 SP donor nephrectomies were compared with 30 laparoscopic donor nephrectomies performed during the same period. For recipient analysis, 15 simultaneous SP kidney transplants were compared with 30 isolated SP kidney transplants (Figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eSurgical Technique\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe overall workflow, including donor and recipient procedures and robotic transition, is illustrated in Online Resource 1\u003c/p\u003e\n\u003cp\u003eIn simultaneous SP transplantation, both donor nephrectomy and recipient procedures are performed using the SP robotic platform. Procedures are conducted in adjacent operating rooms, with the donor surgery initiated first. In the recipient operating room, the patient is brought in approximately 30-45 minutes prior to kidney extraction. Anesthesia is induced, and the patient is prepped and draped. \u0026nbsp;A midline or Pfannenstiel incision is performed, followed by blunt development of the extraperitoneal space and SP port placement.\u003c/p\u003e\n\u003cp\u003eAfter kidney extraction, the graft undergoes back-table preparation per our robotic protocol (typically 20–40 minutes). During this interval, the donor is closed, and the robotic system is relocated and docked in the recipient's operating room, allowing the transplant to proceed using the same SP platform. A schematic of the operating room setup and robotic transition is shown in Figure 2.\u003c/p\u003e\n\u003cp\u003eIn the isolated SP group, donor and recipient procedures were performed independently. The recipient was typically brought into the operating room approximately 1 hour prior to kidney extraction. Following donor nephrectomy and back table preparation, the graft was transferred to a separate operating room where the SP robot had already been docked for vessel bed preparation and the subsequent transplant operation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eData Collection\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDemographic, clinical, and perioperative variables were retrospectively collected from the electronic medical record. These included donor and recipient age, sex, body mass index (BMI), preoperative creatinine, dialysis status, and history of prior abdominal surgery, as well as operative metrics.\u003c/p\u003e\n\u003cp\u003eRenal function in donors and graft function in recipients was assessed using serum creatinine. In donors, creatinine was recorded at discharge, 2 weeks, and 1 month postoperatively. In recipients, creatinine was recorded at discharge and 3 months post-transplant. Delayed graft function (DGF) was defined as any dialysis within the first postoperative week.\u003c/p\u003e\n\u003cp\u003eKey surgical parameters, including warm ischemia time (WIT), cold ischemia time (CIT), anastomosis time, and total operative time, were recorded. Total operative time was defined as the interval from skin incision to skin closure. Postoperative pain was assessed using the visual analog scale (VAS).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eStatistical Analysis\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBaseline demographic and clinical characteristics were compared between donor groups (SP donor nephrectomy vs laparoscopic donor nephrectomy) and recipient groups (simultaneous SP vs isolated SP kidney transplantation). Continuous variables were expressed as medians (interquartile range [IQR]) and compared using the Mann–Whitney U test. Categorical variables were compared using the chi-square or Fisher’s exact test, as appropriate.\u003c/p\u003e\n\u003cp\u003eAll analyses were performed using JASP (version 0.19.3; Amsterdam, Netherlands) and R (version 4.5.2; R Foundation for Statistical Computing, Vienna, Austria). A two-sided p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 45 living donor kidney transplants were analyzed: 15 simultaneous SP donor–recipient cases and 30 cases with laparoscopic donor nephrectomy followed by isolated SP kidney transplantation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eDonor Characteristics and Outcomes\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDonor characteristics and outcomes are summarized in Table 1. Baseline characteristics were comparable between groups. The median donor age was 44 years (IQR 38.5–53.8) in the SP donor nephrectomy group and 49 years (IQR 38–60.5) in the laparoscopic donor nephrectomy group (p=0.56). Female donors comprised 66.6% and 90% of groups, respectively (p=0.06). Median BMI (29.5 vs 27.4 kg/m², p=0.20) and preoperative creatinine (0.87 vs 0.86 mg/dL, p=0.87) were similar.\u003c/p\u003e\n\u003cp\u003eMedian operative time was longer in the SP donor nephrectomy group (4 hours 10 minutes [IQR 4:02–4:19] vs 3 hours 7 minutes [IQR 2:49–3:29], p=0.001). The proportion of left donor nephrectomy was similar (93.3% in both groups, p=1.00). Median warm ischemia time was 3 minutes in both groups (p=0.70), and estimated blood loss was 50 mL in both groups, p=0.40.\u003c/p\u003e\n\u003cp\u003ePostoperative pain scores were lower in the SP group on postoperative day 1 (median 6 [IQR 5.5–7] vs 7 [IQR 6.25–8], p=0.03), with no difference on day 2 (p=0.06). Length of stay was similar between groups (median 2 days in both groups, p=0.56). Donor renal function was comparable at discharge, 2 weeks, and 1 month. One patient (6.6%) in the SP group developed a wound infection, while none occurred in the laparoscopic group (p=0.15). Thirty-day readmission occurred in one patient (6.6%) in the SP group and none in the laparoscopic group (p=0.15).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eRecipient Characteristics and Outcomes\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRecipient characteristics and outcomes are summarized in Table 2. Baseline characteristics were comparable between groups. The median age was 42.8 years (IQR 32.6–58.1) in the simultaneous SP group and 50.6 years (IQR 47.6–59.9) in the isolated SP group (p=0.11). Median BMI (30.3 vs 31.4 kg/m², p=0.40), rate of pre-emptive transplantation (46.6% vs 53.3%, p=0.67), and prior abdominal surgery (27% vs 43.3%, p=0.27) were similar.\u003c/p\u003e\n\u003cp\u003eThe simultaneous SP approach was associated with shorter operative time (3 hours 54 minutes [IQR 3:21–4:22] vs 4 hours 41 minutes [IQR 3:51–5:31], p=0.015) and shorter anastomosis time (44 [IQR 39–45] vs 52.5 [IQR 45.5–65] minutes, p=0.007). Cold ischemia time (1 hour 31 minutes [IQR 1:28–1:43] vs 1 hour 34 minutes [IQR 1:13–2:15], p=0.82) and estimated blood loss (50 mL in both groups, p=0.57) were comparable. Conversion to open surgery occurred in one patient (3.3%) in the isolated SP group and none in the simultaneous SP group (p=0.49).\u003c/p\u003e\n\u003cp\u003ePostoperative outcomes were similar. The median length of stay was 2 days in both groups (p=0.63), and transfusion rates were comparable (6.6% vs 13.3%, p=0.52). Pain scores were similar between groups on postoperative day 1 (p=0.09) and day 2 (p=0.97).\u003c/p\u003e\n\u003cp\u003eGraft function was comparable between groups. Median creatinine at discharge was 1.87 mg/dL vs 2.54 mg/dL (p=0.06), with similar values at 3 months (1.40 vs 1.48 mg/dL, p=0.15). DGF occurred in two patients (6.7%) in the isolated SP group and none in the simultaneous SP group (p=0.37).\u003c/p\u003e\n\u003cp\u003eThirty-day readmission occurred in 6 recipients (40%) in the simultaneous SP group and 8 patients (26.6%) in the isolated SP group (p=0.28). Hematoma occurred in one patient (3.3%) in the isolated SP group, while symptomatic lymphocele occurred in one patient in each group (p=0.71).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eKidney transplantation has undergone significant evolution over the past decade, with advances in surgical technology contributing to safer procedures, faster recovery, and improved patient outcomes [10-12, 16-18, 23]. The adoption of robotic platforms has emerged as an evolving development in kidney transplantation. The introduction of the SP robotic system enabled an extraperitoneal approach for recipient surgery, allowing patients to remain in the supine position and thereby avoiding the hemodynamic alterations associated with pneumoperitoneum and Trendelenburg positioning. Additionally, the SP platform facilitates donor surgery through a single transumbilical incision, potentially reducing morbidity. Our institution was among the first to pioneer SP robotic kidney transplantation in 2019, establishing the feasibility of this approach in the recipient population [9]. Building on this progress, Garden et al. [6] reported their initial experience with SP robotic donor nephrectomy in 2021, demonstrating the technical feasibility and cosmetic advantages of using an SP approach for healthy donors. This momentum has prompted broader exploration into how the SP platform can be applied across transplant surgery.\u003c/p\u003e\n\u003cp\u003eImplementing the SP platform for both donor nephrectomy and kidney transplantation remains challenging, particularly due to cost and availability of robotic systems [21, 22]. \u0026nbsp;Most centers have access to only one SP robot, making it difficult to coordinate both procedures in close succession. This requires intraoperative planning to prevent delays that could prolong anesthesia or cold ischemia time, both associated with worse graft outcomes [24,25]. Successful implementation depends on close team coordination, efficient OR transitions, and precise robotic management; without an integrated workflow, sharing a single robot for two complex procedures may undermine efficiency and the benefits of minimally invasive surgery.\u003c/p\u003e\n\u003cp\u003eEspecially for kidney transplant donors, who are healthy individuals undergoing elective surgery, minimizing surgical morbidity and maximizing cosmetic outcomes is important. Laparoscopic donor nephrectomy is currently considered the gold standard approach. Compared with open donor nephrectomy, it provides equivalent renal outcomes while offering improved postoperative recovery [5-7].\u0026nbsp;Prior studies have shown that minimally invasive surgery for donors has increased the donation rates among kidney transplant donors [26]. The SP approach offers distinct advantages over traditional laparoscopic donor nephrectomy, which typically requires multiple trocar incisions in addition to the extraction site. In contrast, SP procedures are performed through a single, concealed umbilical incision, enhancing cosmetic outcomes, and potentially improving donor satisfaction and recovery [27].\u0026nbsp;In our donor cohort, SP donor nephrectomy was associated with a longer operative time compared to laparoscopic approach. This can be explained by the expected learning curve associated with the adoption of a new technique. Importantly, despite the increased operative duration, warm ischemia time remained comparable between groups, suggesting that graft retrieval efficiency was not compromised. Furthermore, postoperative pain scores were significantly lower on postoperative day 1 in the SP group, indicating a potential early recovery benefit.\u0026nbsp;Our findings are consistent with Palese et al. [28] who reported the largest SP donor nephrectomy series to date and demonstrated reduced postoperative opioid requirements with similar pain scores and comparable perioperative outcomes between SP and laparoscopic donor nephrectomy.\u003c/p\u003e\n\u003cp\u003eFrom an operational standpoint, the choreography of this simultaneous approach represents a novel application of surgical logistics. The natural delay between donor kidney extraction, closure of the donor and graft implantation—typically used for bench preparation of the graft—creates a critical 30 to 40 minute window [29]. Within this period, the SP robot can be undocked from the donor room, transferred, re-draped and re-docked in the recipient room, allowing the transplant procedure to begin promptly.\u003c/p\u003e\n\u003cp\u003eOur data demonstrates that recipient operative and anastomosis times were shorter in the simultaneous SP group. This likely reflects improved operating room efficiency and a streamlined workflow enabled by the coordinated simultaneous approach. In the simultaneous SP group, recipient induction was deliberately timed approximately 30–45 minutes prior to kidney extraction and was often delayed until the robotic platform became available for transfer to the recipient OR, potentially minimizing idle operative time.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Another contributing factor may be increasing institutional experience with the SP platform. By the time the simultaneous cases were performed, the surgical team had likely surpassed the initial learning curve associated with SP kidney transplantation. Improved familiarity with instrumentation, patient positioning, and docking may therefore have contributed to reduced operative duration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSuccessful implementation of this workflow requires more than access to robotic technology; it depends on a well-trained and coordinated multidisciplinary team. Technical and logistical challenges remain important considerations, as robot relocation must be performed efficiently, typically during graft preparation, to avoid operative downtime.\u003c/p\u003e\n\u003cp\u003eOur experience highlights several important considerations and potential applications. Notably, the same simultaneous approach could be adapted to the da Vinci Xi platform, offering a novel strategy to provide both donors and recipients with access to robotic surgery using a single robotic system. This concept may be particularly valuable for transplant centers with limited access to robotic platforms, as it could broaden the integration of robotic technology into both donor and recipient procedures. Additionally, this approach has implications for cost-effectiveness. By maximizing the use of a one robot across two procedures, institutions may achieve improved resource utilization and potentially reduce the cost per case [21-22].\u003c/p\u003e\n\u003cp\u003eAlthough our study was not powered to detect statistical significance across all outcome measures, the observed trends in operative efficiency and early clinical outcomes are encouraging. One open conversion occurred in the isolated SP cohort, otherwise no major intraoperative complications or conversions were noted. Donor and recipient lengths of stay and discharge creatinine levels were comparable. Importantly, this approach was logistically sustainable across fifteen consecutive cases, supporting its reproducibility and potential applicability in other high-volume centers.\u003c/p\u003e\n\u003cp\u003eThis study is limited by its retrospective design and relatively small sample size, particularly in the simultaneous SP group, which may reduce statistical power. As a single-center experience from a high-volume robotic transplant program, the findings may not be generalizable to centers with different expertise or resources. Additionally, the simultaneous approach requires specific institutional logistics, including access to adjacent operating rooms and coordinated workflows, which may limit broader applicability. Finally, long-term outcomes and cost-effectiveness were not assessed and warrant further study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that a coordinated, simultaneous SP robotic approach for living donor nephrectomy and kidney transplantation is feasible, safe, and reproducible using a single SP platform. With appropriate planning, experienced teams, and optimized workflow, this strategy enables efficient utilization of robotic resources without compromising perioperative or transplant outcomes. Notably, this approach was associated with improved operative efficiency, reflected by shorter recipient operative times. It offers a practical solution for centers with limited access to multiple robotic systems and has the potential to enhance operating room efficiency. Further multicenter studies are warranted to validate these findings, assess long-term outcomes, and define the broader applicability of this model.\u003c/p\u003e"},{"header":"Statements and Declarations","content":"\u003cp\u003e\u003cem\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eEthical Approval\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Cleveland Clinic Human Research Ethics Committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eConsent to participate\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003e\u003cu\u003eConsent to publish\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eFunding:\u0026nbsp;\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNone\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthor contributions:\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Hafiz Umair Siddiqui and Mohamed Eltemamy conceptualized the study. Material preparation, data collection and analysis were performed by Hafiz Umair Siddiqui, Adam Esa, Dylan Isaacson and Sami Shoucair. Mohamed Eltemamy, Alvin Wee, Yi-Chia Lin performed the robotic procedure. Venkatesh Krishnamurthi, Jihad Kaouk and Mohamed Eltemamy contributed to technical description. The first draft of the manuscript was written by Hafiz Umair Siddiqui and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, M.E, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New England journal of medicine. 1999 Dec 2;341(23):1725-30.\u003c/li\u003e\n \u003cli\u003eSchnuelle P, Lorenz D, Trede M, Van Der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol. 1998 Nov;9(11):2135-41. doi: 10.1681/ASN.V9112135. PMID: 9808102.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePort FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993 Sep 15;270(11):1339-43. PMID: 8360969.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRatner LE, Ciseck LJ, MooRE RG, Cigarroa FG, Kaufman HS, Kavoussi LR. Laparoscopic live donor nephrectomy. Transplantation-Baltimore. 1995 Nov 15;60(9):1047-9.\u003c/li\u003e\n \u003cli\u003eHorgan S, Vanuno D, Sileri P, Cicalese L, Benedetti E. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation. 2002 May 15;73(9):1474-9.\u003c/li\u003e\n \u003cli\u003eGarden EB, Al-Alao O, Razdan S, Mullen GR, Florman S, Palese MA. Robotic Single-Port Donor Nephrectomy with the da Vinci SP\u0026reg; Surgical System. JSLS. 2021;25(4):e2021.00062. doi:10.4293/JSLS.2021.00062\u003c/li\u003e\n \u003cli\u003eRosales A, Salvador JT, Urdaneta G, Patino D, Montlle\u0026oacute; M, Esquena S, Caffaratti J, de Leon JP, Guirado L, Villavicencio H. Laparoscopic kidney transplantation. European urology. 2010 Jan 1;57(1):164-7.\u003c/li\u003e\n \u003cli\u003eGiulianotti P, Gorodner V, Sbrana F, Tzvetanov I, Jeon H, Bianco F, Kinzer K, Oberholzer J, Benedetti E. Robotic transabdominal kidney transplantation in a morbidly obese patient. American Journal of Transplantation. 2010 Jun;10(6):1478-82.\u003c/li\u003e\n \u003cli\u003eKaouk J, Eltemamy M, Aminsharifi A, Schwen Z, Wilson C, Abou Zeinab M, Garisto J, Lenfant L, Wee A. Initial experience with single-port robotic-assisted kidney transplantation and autotransplantation. European urology. 2021 Sep 1;80(3):366-73.\u003c/li\u003e\n \u003cli\u003eSimforoosh N, Basiri A, Tabibi A, Shakhssalim N, Hosseini Moghaddam SM. Comparison of laparoscopic and open donor nephrectomy: a randomized controlled trial. BJU international. 2005 Apr;95(6):851-5.\u003c/li\u003e\n \u003cli\u003eKhajeh E, Nikbakhsh R, Ramouz A, Majlesara A, Golriz M, Mueller-Stich BP, Nickel F, Morath C, Zeier M, Mehrabi A. Robot-assisted versus laparoscopic living donor nephrectomy: superior outcomes after completion of the learning curve. Journal of Robotic Surgery. 2023 Oct;17(5):2513-26.\u003c/li\u003e\n \u003cli\u003eSpaggiari M, Garcia-Roca R, Tulla KA, Okoye OT, Di Bella C, Oberholzer J, Jeon H, Tzvetanov IG, Benedetti E. Robotic assisted living donor nephrectomies: a safe alternative to laparoscopic technique for kidney transplant donation. Annals of surgery. 2022 Mar 1;275(3):591-5.\u003c/li\u003e\n \u003cli\u003eChin CP, Levy M, Awan M, Palese M. Single-Port and Multi-Port Robotic Donor Nephrectomy. Journal of Endourology. 2025 Mar 1;39(S1):S66-71.\u003c/li\u003e\n \u003cli\u003eDagn\u0026aelig;s-Hansen J, Kristensen GH, Stroomberg HV, S\u0026oslash;rensen SS, R\u0026oslash;der MA. Surgical approaches and outcomes in living donor nephrectomy: a systematic review and meta-analysis. European urology focus. 2022 Nov 1;8(6):1795-801.\u003c/li\u003e\n \u003cli\u003eMenon M, Abaza R, Sood A, et al. Robotic kidney transplantation with regional hypothermia: evolution of a novel procedure utilizing the IDEAL guidelines (IDEAL phase 0 and 1). Eur Urol. 2014;65(5):1001-1009.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTzvetanov IG, Spaggiari M, Tulla KA, et al. Robotic kidney transplantation in the obese patient: 10-year experience from a single center. Am J Transplant. 2020;20(2):430-440.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTerrito A, Afferi L, Musquera M, et al. Robot-assisted kidney transplantation: the 8-year European experience. Eur Urol. 2025;87(4):468-475.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSlagter JS, Outmani L, Tran KT, Ijzermans JN, Minnee RC. Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: A systematic review and meta-analyses. International Journal of Surgery. 2022 Mar 1;99:106264.\u003c/li\u003e\n \u003cli\u003eHaberal\u0026nbsp;HB,\u0026nbsp;Donmez\u0026nbsp;MI, L\u0026oacute;pez-Abad A, et al. Emerging technology in kidney transplantation: the single-port robot-assisted system.\u0026nbsp;J Robot Surg.\u0026nbsp;2025;19(1):265.\u003c/li\u003e\n \u003cli\u003eKaouk J, Aminsharifi A, Sawczyn G, Kim S, Wilson CA, Garisto J, Fareed K. Single-port robotic urological surgery using purpose-built single-port surgical system: single-institutional experience with the first 100 cases. Urology. 2020 Jun 1;140:77-84.\u003c/li\u003e\n \u003cli\u003eMoschovas MC, Helman T, Bhat S, Sandri M, Rogers T, Noel J, Reddy S, Corder C, Patel V. Does type of robotic platform make a difference in the final cost of robotic-assisted radical prostatectomy?. Journal of Robotic Surgery. 2022 Dec;16(6):1329-35.\u003c/li\u003e\n \u003cli\u003eChilders CP, Maggard-Gibbons M. Estimation of the acquisition and operating costs for robotic surgery. Jama. 2018 Aug 28;320(8):835-6.\u003c/li\u003e\n \u003cli\u003eD1 Tzvetanov IG, Tulla KA, Di Cocco P, Spaggiari M, Benedetti E. Robotic kidney transplant: the modern era technical revolution. Transplantation. 2022 Mar 1;106(3):479-88.\u003c/li\u003e\n \u003cli\u003eFoley ME, Vinson AJ, Skinner TA, Kiberd BA, Tennankore KK. The impact of combined warm and cold ischemia time on post-transplant outcomes. Canadian Journal of Kidney Health and Disease. 2023 Jun;10:20543581231178960.\u003c/li\u003e\n \u003cli\u003evan de Laar SC, Lafranca JA, Minnee RC, Papalois V, Dor FJ. The impact of cold ischaemia time on outcomes of living donor kidney transplantation: a systematic review and meta-analysis. Journal of Clinical Medicine. 2022 Mar 15;11(6):1620.\u003c/li\u003e\n \u003cli\u003eSchweitzer EJ, Wilson J, Jacobs S, Machan CH, Philosophe B, Farney A, Colonna J, Jarrell BE, Bartlett ST. Increased rates of donation with laparoscopic donor nephrectomy. Annals of surgery. 2000 Sep 1;232(3):392-400\u003c/li\u003e\n \u003cli\u003eWang D, Connors C, Villada JS, Kim E, Snyder J, Levy M, Chin CP, Rudow DL, Chin E, Benvenisty A, Shapiro R. Understanding Decision Making and Post-Donation Experiences for Robotic Single Port and Laparoscopic Donor Nephrectomy. InTransplantation Proceedings 2025 Nov 2. Elsevier.\u003c/li\u003e\n \u003cli\u003ePalese MA, Chin CP, Garden EB, Eilender B, Levy M, Ravivarapu KT, Wang D, Freid H, Al-Alao O, Araya JS, LaPointe-Rudow D. Comparison of single-port robotic donor nephrectomy and laparoscopic donor nephrectomy. Journal of Endourology. 2024 Feb;38(2):136-41.\u003c/li\u003e\n \u003cli\u003eSlagter JS, Rijkse E, De Wilde RF, Haen R, Lepiesza A, Cappelle ML, Kimenai DH, Minnee RC. The effect of recipient back-table duration on graft outcome of deceased donor kidneys: a single-center prospective cohort study. Journal of Clinical Medicine. 2023 Apr 2;12(7):2647.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 672px;\"\u003e\n \u003cp\u003eTable 1:\u0026nbsp;Donor Outcomes: Simultaneous Single-Port vs. Laparoscopic Donor Nephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDonor Data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP Donor Nephrectomy\u003c/strong\u003e\u003cbr\u003e \u003cstrong\u003e(n=15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic Donor Nephrectomy\u003c/strong\u003e\u003cbr\u003e \u003cstrong\u003e(n=30)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eAge \u003cem\u003e(year, median, IQR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e44 (38.5-53.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e49 (38-60.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;Female (\u003cem\u003en, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;10 (66.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;27 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eBMI \u003cem\u003e(kg/m\u003csup\u003e2\u003c/sup\u003e, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e29.5 (27-32.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e27.4 (24.5-31.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003ePreoperative creatinine \u003cem\u003e(mg/dL, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.87(0.78-0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e0.86 (0.76-0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eTotal Nephrectomy time\u0026nbsp;(\u003cem\u003ehh:min\u003c/em\u003e, median, \u003cem\u003eIQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e04:10 (04:02-04:19)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e03:07 (02:49-03:29)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eLeft Kidney used \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;14 (93.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;28 (93.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eWarm Ischemia \u003cem\u003e(minutes, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3 (3-4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e3 (2-4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eEstimated blood loss \u003cem\u003e(mL\u003c/em\u003e, \u003cem\u003emedian, IQR)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e50 (32-50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e50 (25-50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003ePostoperative Pain Score (\u003cem\u003emedian, IQR)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003cul type=\"square\"\u003e\n \u003cli\u003eDay 1 \u0026nbsp; \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDay 2 \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (5.5-7)\u003c/p\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (6.25-8)\u003c/p\u003e\n \u003cp\u003e5 (4.5-7.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cbr\u003e \u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eCreatinine at discharge \u003cem\u003e(mg/dL, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.26 (1.04-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e1.28 (1.15-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eLength of Stay \u003cem\u003e(days, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2 (1-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e2 (1.25-2)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eCreatinine at 2 weeks (\u003cem\u003emg/dL, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.16 (1.01-1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e1.19 (1.06-1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eCreatinine at 1 month (\u003cem\u003emg/dL, median, IQR\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.05 (1.01-1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e1.01 (0.75-1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eWound infection \u003cem\u003e(n, %\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1 (6.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003e30-day Readmission \u003cem\u003e(n, %\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 672px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Recipient Outcomes: Simultaneous vs. Isolated Single Port Kidney Transplantation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecipient Data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimultaneous SP Transplant\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e \u003cstrong\u003e(n=15)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIsolated SP Transplant\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u003cstrong\u003eP Value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cem\u003eDemographics\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eAge \u003cem\u003e(year, median, IQR)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e42.8 (32.6-58.1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e50.6 (47.6-59.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eGender Female \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026nbsp;5 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;11 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eBMI\u0026nbsp;(\u003cem\u003ekg/m\u003csup\u003e2\u003c/sup\u003e, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e30.3 (25.7-33.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e31.4 (28.5-33.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003ePre-Emptive \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e7 (46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e16 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCause of ESRD \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eDM / HTN\u003c/li\u003e\n \u003cli\u003eADPKD\u003c/li\u003e\n \u003cli\u003eFSGS\u003c/li\u003e\n \u003cli\u003eIgA nephropathy\u003c/li\u003e\n \u003cli\u003eOther\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (53.3%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e1 (6.7%)\u003c/p\u003e\n \u003cp\u003e2 (13.3%)\u003c/p\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (30%)\u003c/p\u003e\n \u003cp\u003e6 (20%)\u003c/p\u003e\n \u003cp\u003e5 (16.6)\u003c/p\u003e\n \u003cp\u003e2 (6.67%)\u003c/p\u003e\n \u003cp\u003e8 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003ePrevious abdominal surgeries \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e4 (27%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e13 (43.3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cem\u003eOperative Data\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eTotal Operative time (\u003cem\u003ehh:min\u003c/em\u003e, median, \u003cem\u003eIQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e03:54 (03:21-04:22)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e04:41 (03:51-5:31)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.015\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eAnastomosis time \u003cem\u003e(minutes, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e44 (39-45)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e52.5 (45.5-65)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCold Ischemia\u0026nbsp;(\u003cem\u003ehh:min\u003c/em\u003e, median, \u003cem\u003eIQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e01:31 (01:28-01:43)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e01:34 (01:13-02:15)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eEstimated blood loss \u003cem\u003e(mL\u003c/em\u003e, \u003cem\u003emedian, IQR)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e50 (50-62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e50 (28.5-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eConversion to open \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cem\u003ePost Operative Outcomes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eLength of Stay \u003cem\u003e(days, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e2 (2-3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2 (2-3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eBlood Transfusion \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e4 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003ePostoperative Pain median \u003cem\u003e(median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003cul type=\"square\"\u003e\n \u003cli\u003eDay 1 \u0026nbsp; \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDay 2 \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (3-6)\u003c/p\u003e\n \u003cp\u003e4 (2.5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.25 (3-6)\u003c/p\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCreatinine at discharge \u003cem\u003e(mg/dL, median, IQR\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1.87 (1.55-2.33)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.54 (1.86-3.12)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eDGF \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2 (6.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e30-day Readmission \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e6 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e8 (26.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eLymphocele \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eHematoma \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCreatinine at 3 months \u003cem\u003e(mg/dL, median, IQR)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1.40 (1.21-1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.48 (1.26-1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Single port robotic kidney transplantation, Single port donor nephrectomy RAKT, Living donor, Perioperative outcomes, Robotic Surgery","lastPublishedDoi":"10.21203/rs.3.rs-9511569/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9511569/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Single-port (SP) robotic platforms are enabling new approaches to living donor nephrectomy and kidney transplantation, but limited access to robotic systems may prevent simultaneous donor and recipient procedures. This retrospective cohort study evaluated the feasibility, safety, and efficiency of a simultaneous SP robotic workflow using a single robotic platform for both operations. 45 living kidney donor/recipient operations were performed between October 2019 and September 2025. 15 pairs underwent a simultaneous SP robotic approach in which both donor nephrectomy and recipient transplant were completed using the same SP robotic platform, while 30 cases underwent laparoscopic donor nephrectomy followed by SP robotic kidney transplantation. Outcomes included operative time, graft ischemia times, perioperative complications, pain scores, length of stay, and graft function. Baseline donor characteristics were similar between groups. SP robotic donor nephrectomy had longer operative time than laparoscopic nephrectomy (median 4:10 vs 3:07 hours, p=0.001), while warm ischemia time, blood loss, length of stay, and renal function were comparable. Donors in the SP group reported lower postoperative day 1 pain scores (p=0.03). In recipients, the simultaneous SP robotic approach resulted in a shorter operative time (3:54 vs 4:41 hours, p=0.015) and anastomosis time (44 vs 52.5 minutes, p=0.007), with no differences in cold ischemia time, complications, or graft function. Overall, a simultaneous SP robotic strategy using a shared platform is feasible, safe, and improves operative efficiency without compromising outcomes.","manuscriptTitle":"Feasibility of Simultaneous Donor Nephrectomy and Kidney Transplantation Using a Shared Single-Port Robotic Platform","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 17:20:09","doi":"10.21203/rs.3.rs-9511569/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T12:06:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T02:34:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T14:45:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91506341566035595983024389821196459108","date":"2026-05-02T23:22:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282037021912914811995447905376002760019","date":"2026-05-02T06:03:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5192695051994544147912566812668552381","date":"2026-05-01T13:36:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319389235260181112053891295778097355921","date":"2026-05-01T11:48:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-01T11:38:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-25T18:23:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-25T02:12:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2026-04-24T02:40:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1f355625-a0b0-4444-97c2-a290bb1de77f","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T12:06:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T02:34:56+00:00","index":94,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T14:45:31+00:00","index":91,"fulltext":""},{"type":"reviewerAgreed","content":"91506341566035595983024389821196459108","date":"2026-05-02T23:22:20+00:00","index":87,"fulltext":""},{"type":"reviewerAgreed","content":"282037021912914811995447905376002760019","date":"2026-05-02T06:03:18+00:00","index":86,"fulltext":""},{"type":"reviewerAgreed","content":"5192695051994544147912566812668552381","date":"2026-05-01T13:36:36+00:00","index":84,"fulltext":""},{"type":"reviewerAgreed","content":"319389235260181112053891295778097355921","date":"2026-05-01T11:48:40+00:00","index":83,"fulltext":""},{"type":"reviewersInvited","content":"77","date":"2026-05-01T11:38:38+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T17:20:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 17:20:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9511569","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9511569","identity":"rs-9511569","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}