Fast track hand-assisted laparoscopic donor nephrectomy: A randomized clinical trial

Feasibility, Safety and Efficacy of Enhanced Recovery after Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Of these, 103 articles were excluded (10 studies involving ERAS protocols for renal transplant recipients; 27 conference abstracts with either insufficient information or duplicated data; 8 commentaries, systematic reviews, study protocols; 3 because patients with major complications were excluded; 3 because the relevant outcome data were not reported; 1 because there was no comparator; 3 because paediatric patients were enrolled; 3 because patients undergoing nephrectomy for cancer were included; 45 because they involved solitary interventions). Overall, 11 studies, 4 RCTs and 7 non-randomized cohort studies were included in the present systematic review [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

“…With regard to preoperative interventions, outpatient consultation for setting recovery goals [ 10 , 12 , 13 , 17 , 19 , 20 ], carbohydrate loading (with avoidance of peri-operative fasting) [ 10 , 12 , 13 , 15 , 19 , 20 ] and pre-emptive analgesia loading [ 11 , 19 , 20 ] were the most common ERAS elements encountered. Intraoperatively, the infiltration of local anaesthetic in the epidural space [ 12 , 13 , 15 , 16 ], the use of Transversus Abdominis Plane (TAP) blocks [ 19 , 20 ], and the insertion of local anaesthetic wound infiltration catheters [ 10 , 18 ] were the three most prominent ERAS interventions. Postoperatively, initiation of nutrition [ 10 , 12 , 13 , 17 , 19 , 20 ] and mobilization [ 10 , 12 , 13 , 17 , 20 ] from POD0 were common ERAS elements.…”

“…With regard to postoperative pain management, nonsteroid anti-inflammatory drugs (NSAIDs) were the basic ERAS analgesic regime [ 11 , 13 , 14 , 16 , 19 , 20 ]. The administration of local anaesthetic through an epidural catheter [ 12 , 13 , 15 ] or through a wound infiltration catheter [ 10 , 15 , 18 ] was used to complement analgesic medications in the included studies. Three out of the eleven studies included in our systematic review defined specific clinical discharge criteria in their ERAS protocols [ 12 , 13 , 20 ].…”

“…With regard to the safety of the ERAS protocols, none of the included studies reported any perioperative deaths. ERAS donors tended to have lower overall incidence of postoperative complications compared to standard care donors’ [ 13 , 15 , 17 ]. This primarily referred to Clavien–Dindo I-II complications; Clavien–Dindo III-V were not reported [ 13 , 15 , 17 ].…”

“…Four randomized controlled trials, corresponding to a population of 343 living kidney donors, were included in the present meta-analysis [ 11 , 13 , 14 , 15 ]. With regard to donors’ characteristics, between the ERAS and standard care groups, there were no significant differences for age (95CI: −3.528, 1.061) ( p = 0.292) (I 2 = 0%, Het.…”