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Meta-Analysis
. 2024 May 9;5(5):CD006124.
doi: 10.1002/14651858.CD006124.pub3.

Robotic versus laparoscopic versus open nephrectomy for live kidney donors

Georgios Kourounis  1   2 , Samuel J Tingle  1   2 , Thomas J Hoather  3 , Emily R Thompson  2 , Alistair Rogers  4 , Tobias Page  4 , Aliu Sanni  5 , David A Rix  4 , Naeem A Soomro  4 , Colin Wilson  1   2
Affiliations
Meta-Analysis

Robotic versus laparoscopic versus open nephrectomy for live kidney donors

Georgios Kourounis et al. Cochrane Database Syst Rev. .

Abstract

Background: Waiting lists for kidney transplantation continue to grow. Live kidney donation significantly reduces waiting times and improves long-term outcomes for recipients. Major disincentives to potential kidney donors are the pain and morbidity associated with surgery. This is an update of a review published in 2011.

Objectives: To assess the benefits and harms of open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), hand-assisted LDN (HALDN) and robotic donor nephrectomy (RDN) as appropriate surgical techniques for live kidney donors.

Search methods: We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 31 March 2024 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov.

Selection criteria: Randomised controlled trials (RCTs) comparing LDN with ODN, HALDN, or RDN were included.

Data collection and analysis: Two review authors independently screened titles and abstracts for eligibility, assessed study quality, and extracted data. We contacted study authors for additional information where necessary. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Main results: Thirteen studies randomising 1280 live kidney donors to ODN, LDN, HALDN, or RDN were included. All studies were assessed as having a low or unclear risk of bias for selection bias. Five studies had a high risk of bias for blinding. Seven studies randomised 815 live kidney donors to LDN or ODN. LDN was associated with reduced analgesia use (high certainty evidence) and shorter hospital stay, a longer procedure and longer warm ischaemia time (moderate certainty evidence). There were no overall differences in blood loss, perioperative complications, or need for operations (low or very low certainty evidence). Three studies randomised 270 live kidney donors to LDN or HALDN. There were no differences between HALDN and LDN for analgesia requirement, hospital stay (high certainty evidence), duration of procedure (moderate certainty evidence), blood loss, perioperative complications, or reoperations (low certainty evidence). The evidence for warm ischaemia time was very uncertain due to high heterogeneity. One study randomised 50 live kidney donors to retroperitoneal ODN or HALDN and reported less pain and analgesia requirements with ODN. It found decreased blood loss and duration of the procedure with HALDN. No differences were found in perioperative complications, reoperations, hospital stay, or primary warm ischaemia time. One study randomised 45 live kidney donors to LDN or RDN and reported a longer warm ischaemia time with RDN but no differences in analgesia requirement, duration of procedure, blood loss, perioperative complications, reoperations, or hospital stay. One study randomised 100 live kidney donors to two variations of LDN and reported no differences in hospital stay, duration of procedure, conversion rates, primary warm ischaemia times, or complications (not meta-analysed). The conversion rates to ODN were 6/587 (1.02%) in LDN, 1/160 (0.63%) in HALDN, and 0/15 in RDN. Graft outcomes were rarely or selectively reported across the studies. There were no differences between LDN and ODN for early graft loss, delayed graft function, acute rejection, ureteric complications, kidney function or one-year graft loss. In a meta-regression analysis between LDN and ODN, moderate certainty evidence on procedure duration changed significantly in favour of LDN over time (yearly reduction = 7.12 min, 95% CI 2.56 to 11.67; P = 0.0022). Differences in very low certainty evidence on perioperative complications also changed significantly in favour of LDN over time (yearly change in LnRR = 0.107, 95% CI 0.022 to 0.192; P = 0.014). Various different combinations of techniques were used in each study, resulting in heterogeneity among the results.

Authors' conclusions: LDN is associated with less pain compared to ODN and has comparable pain to HALDN and RDN. HALDN is comparable to LDN in all outcomes except warm ischaemia time, which may be associated with a reduction. One study reported kidneys obtained during RDN had greater warm ischaemia times. Complications and occurrences of perioperative events needing further intervention were equivalent between all methods.

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Conflict of interest statement

  1. Georgios Kourounis: No relevant interests were disclosed

  2. Sam Tingle: No relevant interests were disclosed

  3. Thomas Hoather: No relevant interests were disclosed

  4. Emma Thompson: No relevant interests were disclosed

  5. Alistair Rogers: No relevant interests were disclosed

  6. Tobias Page: No relevant interests were disclosed

  7. Aliu Sanni: No relevant interests were disclosed

  8. David Rix: No relevant interests were disclosed

  9. Naeem Soomro: No relevant interests were disclosed

  10. Colin Wilson: No relevant interests were disclosed

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Meta‐regression of procedure duration against publication year
5
5
Meta‐regression of perioperative complications against publication year
6
6
Meta‐regression of warm ischaemia time against publication year
1.1
1.1. Analysis
Comparison 1: Open versus laparoscopic live donor nephrectomy: primary outcomes, Outcome 1: Analgesia requirements
1.2
1.2. Analysis
Comparison 1: Open versus laparoscopic live donor nephrectomy: primary outcomes, Outcome 2: Duration of procedure
1.3
1.3. Analysis
Comparison 1: Open versus laparoscopic live donor nephrectomy: primary outcomes, Outcome 3: Blood loss
1.4
1.4. Analysis
Comparison 1: Open versus laparoscopic live donor nephrectomy: primary outcomes, Outcome 4: Perioperative complications
1.5
1.5. Analysis
Comparison 1: Open versus laparoscopic live donor nephrectomy: primary outcomes, Outcome 5: Reoperations
1.6
1.6. Analysis
Comparison 1: Open versus laparoscopic live donor nephrectomy: primary outcomes, Outcome 6: Warm ischaemia time
1.7
1.7. Analysis
Comparison 1: Open versus laparoscopic live donor nephrectomy: primary outcomes, Outcome 7: Hospital stay
2.1
2.1. Analysis
Comparison 2: Open versus laparoscopic live donor nephrectomy: secondary outcomes, Outcome 1: Early graft loss
2.2
2.2. Analysis
Comparison 2: Open versus laparoscopic live donor nephrectomy: secondary outcomes, Outcome 2: Delayed graft function
2.3
2.3. Analysis
Comparison 2: Open versus laparoscopic live donor nephrectomy: secondary outcomes, Outcome 3: Acute rejection
2.4
2.4. Analysis
Comparison 2: Open versus laparoscopic live donor nephrectomy: secondary outcomes, Outcome 4: Ureteric complications
2.5
2.5. Analysis
Comparison 2: Open versus laparoscopic live donor nephrectomy: secondary outcomes, Outcome 5: Kidney function at one year
2.6
2.6. Analysis
Comparison 2: Open versus laparoscopic live donor nephrectomy: secondary outcomes, Outcome 6: One year graft loss
3.1
3.1. Analysis
Comparison 3: Laparoscopic versus hand‐assisted donor nephrectomy: primary outcomes, Outcome 1: Analgesia requirements
3.2
3.2. Analysis
Comparison 3: Laparoscopic versus hand‐assisted donor nephrectomy: primary outcomes, Outcome 2: Duration of procedure
3.3
3.3. Analysis
Comparison 3: Laparoscopic versus hand‐assisted donor nephrectomy: primary outcomes, Outcome 3: Blood loss
3.4
3.4. Analysis
Comparison 3: Laparoscopic versus hand‐assisted donor nephrectomy: primary outcomes, Outcome 4: Perioperative complications
3.5
3.5. Analysis
Comparison 3: Laparoscopic versus hand‐assisted donor nephrectomy: primary outcomes, Outcome 5: Reoperations
3.6
3.6. Analysis
Comparison 3: Laparoscopic versus hand‐assisted donor nephrectomy: primary outcomes, Outcome 6: Warm ischaemia time
3.7
3.7. Analysis
Comparison 3: Laparoscopic versus hand‐assisted donor nephrectomy: primary outcomes, Outcome 7: Hospital stay
4.1
4.1. Analysis
Comparison 4: Laparoscopic versus hand‐assisted donor nephrectomy: secondary outcomes, Outcome 1: One‐year graft loss
See this image and copyright information in PMC

Update of

References

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