Retroperitoneoscopic Standard or Hand-Assisted Versus Laparoscopic Standard or Hand-Assisted Donor Nephrectomy: A Systematic Review and the First Network Meta-Analysis.Gavriilidis, P. and V. Papalois.
Journal of Clinical Medicine Research 2020; 12(11): 740-746.
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).
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).
8 studies were included in the review.
The outcomes of interest included estimated blood loss (EBL), duration of operation, intraoperative complications, postoperative graft complications, duration of hospital stay and postoperative pain.
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.