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Meta-Analysis
. 2016 May 27;2016(5):CD010850.
doi: 10.1002/14651858.CD010850.pub2.

Laparoendoscopic single-site donor nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy

Ameet Gupta  1 , Kamran Ahmed, Howard G Kynaston, Prokar Dasgupta, Piotr L Chlosta, Omar M Aboumarzouk
Affiliations
Meta-Analysis

Laparoendoscopic single-site donor nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy

Ameet Gupta et al. Cochrane Database Syst Rev. .

Abstract

Background: Advances in minimally invasive surgery for live kidney donors have led to the development of laparoendoscopic single site donor nephrectomy (LESS-DN). At present, laparoscopic donor nephrectomy is the technique of choice for donor nephrectomy globally. Compared with open surgical approaches, laparoscopic donor nephrectomy is associated with decreased morbidity, faster recovery times and return to normal activity, and shorter hospital stays. LESS-DN differs from standard laparoscopic donor nephrectomy; LESS-DN requires a single incision through which the procedure is performed and donor kidney is removed. Previous studies have hypothesised that LESS-DN may provide additional benefits for kidney donors and stimulate increased donor rates.

Objectives: This review looked at the benefits and harms of LESS-DN compared with standard laparoscopic nephrectomy for live kidney donors.

Search methods: We searched the Cochrane Kidney and Transplant's Specialised Register to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review.

Selection criteria: We included randomised controlled trials (RCTs) that compared LESS-DN with laparoscopic donor nephrectomy in adults.

Data collection and analysis: Three authors independently assessed studies for eligibility and conducted risk of bias evaluation. Summary estimates of effect were obtained using a random-effects model and results were expressed as risk ratios (RR) or risk difference (RD) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.

Main results: We included three studies (179 participants) comparing LESS-DN with laparoscopic donor nephrectomy. There were no significant differences between LESS-DN and laparoscopic donor nephrectomy for mean operative time (2 studies, 79 participants: MD 6.36 min, 95% CI -11.85 to 24.57), intra-operative blood loss (2 studies, 79 participants: MD -8.31 mL, 95% CI -23.70 to 7.09), or complication rates (3 studies, 179 participants: RD 0.05, 95% CI -0.04 to 0.14). Pain scores at discharge were significantly less in the LESS-DN group (2 studies, 79 participants: MD -1.19, 95% CI -2.17 to -0.21). For all other outcomes (length of hospital stay; length of time to return to normal activities; blood transfusions; conversion to another form of surgery; warm ischaemia time; total analgesic requirement; graft loss) there were no significant differences observed.Although risk of bias was assessed as low overall, one study was assessed at high risk of attrition bias.

Authors' conclusions: Given the small number and size of included studies it is uncertain whether LESS-DN is better than laparoscopic donor nephrectomy. Well designed and adequately powered RCTs are needed to better define the role of LESS-DN as a minimally invasive option for kidney donor surgery.

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Conflict of interest statement

  1. Ameet Gupta: none known

  2. Kamran Ahmed: none known

  3. Howard G Kynaston: none known

  4. Prokar Dasgupta: none known

  5. Piotr L Chlosta: none known

  6. Omar M Aboumarzouk: none known

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1 Primary outcomes, Outcome 1 Mean operative time.
1.2
1.2. Analysis
Comparison 1 Primary outcomes, Outcome 2 Estimated intra‐operative blood loss.
1.3
1.3. Analysis
Comparison 1 Primary outcomes, Outcome 3 VAS score for pain at discharge.
1.4
1.4. Analysis
Comparison 1 Primary outcomes, Outcome 4 Complications.
2.1
2.1. Analysis
Comparison 2 Secondary outcomes, Outcome 1 Length of hospitalisation.
2.2
2.2. Analysis
Comparison 2 Secondary outcomes, Outcome 2 Length of time to return to normal activities.
2.3
2.3. Analysis
Comparison 2 Secondary outcomes, Outcome 3 Blood transfusion rates.
2.4
2.4. Analysis
Comparison 2 Secondary outcomes, Outcome 4 Conversion rates.
2.5
2.5. Analysis
Comparison 2 Secondary outcomes, Outcome 5 Warm ischaemia time.
2.6
2.6. Analysis
Comparison 2 Secondary outcomes, Outcome 6 Total analgesic requirement.
2.7
2.7. Analysis
Comparison 2 Secondary outcomes, Outcome 7 Graft loss.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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