The safety and efficacy of laparoscopic donor nephrectomy for renal transplantation: an updated meta-analysis.

Currently, the laparoscopic technique is widely used for living donor nephrectomy. Does it provides adequate safety and benefits for the living donor? We performed a meta-analysis to evaluate the safety and efficacy of laparoscopic donor nephrectomy (LDN) as well as an analysis of postoperative quality of life compared with the open donor nephrectomy (ODN). Eligible studies were identified from electronic databases: Cochrane CENTRAL, PubMed, and EMBASE as of October 2011. Relevant parameters explored by-using Review Manager V5.0 included operative time, warm ischemia time, intraoperative blood loss, hospital stay and time to return to work. Compared with ODN, LDN showed a shorter hospital stay (days; mean difference [MD]: -1.27, P < .00001) and time to return to work (days; MD: -16.35, P < .00001), less intraoperative blood loss (ml; MD: -101.23, P = .0001) without an increase among donor intraoperative and postoperative complications or compromise of recipient graft function. Hand-assisted laparoscopic donor nephrectomy (HLDN) showed a shorter warm ischemia time (minutes) than the standard laparoscopic donor nephrectomy (MD: -1.02, P < .00001). We also observed that hospital stay (days) significantly favored SLDN compared with HLDN (MD: 0.33, P < .005), but operative times, intraoperative estimated blood loss, and donor postoperative complications were not significantly different between them. Donor postoperative quality of life revealed only physical functioning and bodily pain scores to significantly favor LDN. LDN is a safe surgical procedure for a living donor.

Yuan H ，Liu L ，Zheng S ，Yang L ，Pu C ，Wei Q ，Han P ... -  《-》

Hand-assisted laparoscopic donor nephrectomy: a comparative study with conventional open donor nephrectomy in a single Chinese center.

Li J ，Wang G ，Zhu T ，Sun L ，Xu M ，Rong R ... -  《TRANSPLANTATION PROCEEDINGS》

Can right-sided hand-assisted retroperitoneoscopic donor nephrectomy be advocated above standard laparoscopic donor nephrectomy: a randomized pilot study.

Endoscopic techniques have contributed to early recovery and increased quality of life (QOL) of live kidney donors. However, laparoscopic donor nephrectomy (LDN) may have its limitations, and hand-assisted retroperitoneoscopic donor nephrectomy (HARP) has been introduced, mainly as a potentially safer alternative. In a randomized fashion, we explored the feasibility and potential benefits of HARP for right-sided donor nephrectomy in a referral center with longstanding expertise on the standard laparoscopic approach. Forty donors were randomly assigned to either LDN or HARP. Primary outcome was operating time, and secondary outcomes included QOL, complications, pain, morphine requirement, blood loss, warm ischemia time, and hospital stay. Follow-up time was 1 year. Skin-to-skin time did not significantly differ between both groups (162 vs. 158 min, P = 0.98). As compared to LDN, HARP resulted in a shorter warm ischemia time (2.8 vs. 3.9 min, P < 0.001) and increased blood loss (187 vs. 50 ml, P < 0.001). QOL, complication rate, pain, or hospital stay was not significantly different between the groups. Right-sided HARP is feasible but does not confer clear benefits over standard right-sided LDN yet. Further studies should explore the value of HARP in difficult cases such as the obese donor and the value of HARP for transplantation centers starting a live kidney donation program (Dutch Trial Register number: NTR3096). Nevertheless, HARP is a valuable addition to the surgical armamentarium in live donor surgery.

Klop KW ，Kok NF ，Dols LF ，Dor FJ ，Tran KT ，Terkivatan T ，Weimar W ，Ijzermans JN ... -  《-》

Comparison of laparoscopic versus hand-assisted live donor nephrectomy.

Kokkinos C ，Nanidis T ，Antcliffe D ，Darzi AW ，Tekkis P ，Papalois V ... -  《TRANSPLANTATION》

Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis.

Nanidis TG ，Antcliffe D ，Kokkinos C ，Borysiewicz CA ，Darzi AW ，Tekkis PP ，Papalois VE ... -  《ANNALS OF SURGERY》