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Review
. 2018 Jul 7;16(3):322-334.
doi: 10.1016/j.aju.2018.02.003. eCollection 2018 Sep.

Laparoscopic and hand-assisted laparoscopic donor nephrectomy: A systematic review and meta-analysis

Mark P Broe  1 , Rose Galvin  2 , Lorna G Keenan  1 , Richard E Power  1
Affiliations
Review

Laparoscopic and hand-assisted laparoscopic donor nephrectomy: A systematic review and meta-analysis

Mark P Broe et al. Arab J Urol. .

Abstract

Objective: To compare the perioperative outcomes of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure LDN, as HALDN and LDN are the two most widely used techniques of DN to treat end-stage renal disease.

Methods: In this systematic review and meta-analysis, we performed a literature search of PubMed, Embase, Web of Science, and Cochrane from 01/01/1995 to 31/12/2014. The primary outcome was conversion to an open procedure. Secondary outcomes were warm ischaemia time (WIT), operation time (OT), estimated blood loss (EBL), complications, and length of stay (LOS). Data analysed were presented as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs), I2, and P values. Subgroup analysis was performed.

Results: There were 24 studies included in the meta-analysis; three randomised controlled trials (RCTs), one randomised pilot study, two prospective, and 18 retrospective cohort studies. There were no differences in conversion to an open procedure between the two techniques for both RCTs (OR 0.42, 95% CI 0.06, 2.90; I2 = 0%, P < 0.001) and cohort studies (OR 1.06, 95% CI 0.63, 1.78; I2 = 0%, P = 0.84). WIT was shorter for the HALDN (-41.79 s, 95% CI -71.85, -11.74; I2 = 96%, P = 0.006), as was the OT (-26.32 min, 95% CI -40.67, -11.97; I2 = 95%, P < 0.001). There was no statistically significant difference in EBL, complications or LOS.

Conclusion: There is little statistical evidence to recommend one technique. HALDN is associated with a shorter WIT and OT. LDN has equal safety to HALDN. Further studies are required.

Keywords: (L)DN, (laparoscopic) donor nephrectomy; BMI, body mass index; EBL, estimated blood loss; FEM, fixed-effects model; HALDN, hand-assisted laparoscopic donor nephrectomy; HARPDN, hand-assisted retroperitoneal donor nephrectomy; Hand-assisted donor nephrectomy; LOS, length of stay; Laparoscopic donor nephrectomy; OR, odds ratio; OT, operation time; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses; RALDN, robot-assisted laparoscopic donor nephrectomy; RCT, randomised controlled trial; REM, random-effects model; Renal transplantation; WIT, warm ischaemia time; WMD, weighted mean difference.

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Figures

Fig. 1
Fig. 1
PRISMA flow chart for study selection.
Fig. 2
Fig. 2
Odds difference in open conversions between all HALDN (experimental) and pure LDN (control) procedures for RCTs.
Fig. 3
Fig. 3
Mean difference in WIT between all HALDN (experimental) and pure LDN (control) procedures for RCTs.
Fig. 4
Fig. 4
Mean difference in operation time between all HALDN (experimental) and pure LDN (control) procedures for RCTs.
Fig. 5
Fig. 5
Odds difference in complications between all HALDN (experimental) and pure LDN (control) procedures for RCTs.
Fig. 6
Fig. 6
Odds difference in open conversions between all HALDN (experimental) and pure LDN (control) procedures for pooled cohort studies.
Fig. 7
Fig. 7
Mean difference in WIT between all HALDN (experimental) and pure LDN (control) procedures for pooled cohort studies.
Fig. 8
Fig. 8
Mean difference operation time between all HALDN (experimental) and pure LDN (control) procedures for pooled cohort studies.
Fig. 9
Fig. 9
Odds difference in complications between all HALDN (experimental) and pure LDN (control) procedures for pooled cohort studies.
See this image and copyright information in PMC

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