Retroperitoneoscopic Standard or Hand-Assisted Versus Laparoscopic Standard or Hand-Assisted Donor Nephrectomy: A Systematic Review and the First Network Meta-Analysis
At the present four minimally invasive procedures namely retroperitoneoscopic (RPDN), laparoscopic (LPDN), hand-assisted retroperitoneoscopic (HARDN) and hand-assisted laparoscopic donor nephrectomy (HALDN) are used to perform donor nephrectomies. The current evidence based on retrospective studies and on pairwise only meta-analyses is inconclusive. Up to authors' best knowledge there is no so far network meta-analysis to compare all the above-mentioned procedures. Therefore, a network meta-analysis was conducted to compare the feasibility, safety and reproducibility of the four donor nephrectomies procedures.
METHODS:Google Scholar, EMBASE, PubMed, and Cochrane library were used for a systematic literature search. Both updated pairwise and network meta-analyses were performed.
RESULTS:Compared to LPDN there was evidence of significantly more right kidneys retrieved with RPDN; nonsignificant differences demonstrated both with HALDN and HARDN compared to LPDN. There was evidence that the operative time was significantly shorter by 77 min in RPDN compared to LPDN; on the other hand, HARDN and HALDN did not demonstrate significant differences when compared to LPDN.
CONCLUSIONS:The present study demonstrates that each approach can be applied safely in adequately selected patients. Moreover, retroperitoneoscopic is reliable, safe and easily reproducible alternative of LPDN for both left and right kidneys.
CET Conclusion
| Reviewer: | Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | The systematic review and network meta-analysis aimed to compare the feasibility, safety and reproducibility of four minimally invasive procedures, i.e. retroperitoneoscopic (RPDN), laparoscopic (LPDN), handassisted retroperitoneoscopic (HARDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). The bibliographic search identified 97 studies of which 8 comparative studies met the inclusion criteria. Data extraction was done in duplicate by independent reviewers. The methodological quality was assessed and all studies were considered to be of high quality. Significantly more right kidneys were retrieved and the operative times was significantly shorter with RPDN and HARDN compared with LPDN and HALDN. The network meta-analysis showed that operative time of RPDN and HARDN was significantly shorter than LPDN and that RPDN retrieved more right kidneys compared with LPDN. No significant differences were found for the other outcomes including warm ischaemic time, intraoperative complications, postoperative graft complications and hospital stay. The authors conclude that each approach is safe and can be adequately applied in selected patients. |
Study Details
| Aims: | This study aimed to compare the feasibility, safety and reproducibility of four types of donor nephrectomies, including retroperitoneoscopic (RPDN), hand-assisted retroperitoneoscopic (HARDN), laparoscopic (LPDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). |
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| Interventions: | Electronic databases including the Cochrane library, MEDLINE (PubMed), EMBASE and Google Scholar were searched. Data extraction was performed independently by two authors. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). |
| Participants: | 8 studies were included in the review. |
| Outcomes: | The outcomes of interest included estimated blood loss (EBL), duration of operation, intraoperative complications, postoperative graft complications, duration of hospital stay and postoperative pain. |
| Follow Up: | N/A |
Metadata
| Funding: | No funding was received for this study |
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| Publication type: | Systematic Review |
| Organ: | Kidney |
| Language: | English |
| Author email: | pgavrielidis@yahoo.com |
| MeSH terms: | Kidney Transplantation |