Introduction: Laparoscopic donor nephrectomy (LDN) is a well-established technique with reduced donor morbidity rates as well as better aesthetics when compared to open approach.  Fully operational da Vinci robotics  systems allows a tremor free stable image, recreates the hand–eye coordination and three-dimensional vision that is lost in standard laparoscopic method for a better outcome.  However the exorbitant price of the robot and its consumables makes it less feasible in low middle income countries. The study describes the outcome of a randomized study where 3-D laparoscope was held by a joystick-controlled robotic arm which is maneuvered by a single surgeon in comparison with the 2 D standard method of donor nephrectomy with a human assistant as cost saving model.
Material: All patients undergoing LDN between March   2015 to September 2017 at Sri Jayawardenapura teaching hospital, Colombo were included.
Method: LDN was performed using 4/ 5(12mmX2, 5mmX 3) port technique, via trans-peritoneal approach where kidney was delivered through a mini pfannenstiel incision. SOLOASSIST (AKTORmed -Germany); a joystick controlled robotic arm system( RA)  was employed to hold the 3D laparoscope every alternative case  in place  of the conventional 2 D camera holding human assistant.  A comparative assessment between the two groups (3D RA donor nephrectomy vs 2D standard LDN) was carried out in terms of patient demography, operative time, outcome, complications, and postoperative hospital stay. The complications were analyzed according to clavien dindo classification. Statistical analysis was carried out using student-t test with p< 0.05 being significant. In addition, the surgeon also performed a subjective evaluation of the camera holding device.
Results: Eighty one donor nephrectomies were performed with 40 using the 3D robotic arm, and the rest (41) with human assistance to hold the 2 D camera. The two groups did not differ significantly in terms of age, sex, body mass index, or American Society of Anesthesiology classification.  The operative time was slightly longer in the 3D RA group (158±28 min), although it was not statistically significant. All surgeries were successfully carried out using laparoscopic technique without converting in to open surgery. Grade 1 and II complications were reported in 10 (i.e in 12.5%) of the cases. The two groups were comparable in terms of complications (p=0.08). Also the mean hospital stay was three days which was comparable in both groups.
Conclusion: The Robotic arm with 3 D technology enables regaining of the hand-eye coordination and three-dimensional view lost in laparoscopic surgery, allows us to perform the donor nephrectomy with greater precision, confidence, and safely. The robotic arm with 3 D technology  can be recommended for performing complex urological surgery in developing countries like Sri Lankan where there is a handful of skilled camera holding assistants with limited financial resources.