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

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), I 2 , 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; I 2  = 0%, P  < 0.001) and cohort studies (OR 1.06, 95% CI 0.63, 1.78; I 2  = 0%, P  = 0.84). WIT was shorter for the HALDN (-41.79 s, 95% CI -71.85, -11.74; I 2  = 96%, P  = 0.006), as was the OT (-26.32 min, 95% CI -40.67, -11.97; I 2  = 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.