Robot‐assisted laparoscopic vs laparoscopic donor nephrectomy in renal transplantation: A meta‐analysis

Abstract

BackgroundCurrently, the robot‐assisted laparoscopic donor nephrectomy (RDN) technique is used for live donor nephrectomy. Does it provide sufficient safety and benefits for living donors? We conducted a meta‐analysis to assess the safety and efficacy of RDN compared with the laparoscopic donor nephrectomy (LDN).Material and methodsEligible studies were retrieved and screened from electronic databases from 1999 onward: PubMed, Cochrane Library, and Web of Science. Relevant parameters were explored using Review Manager V5.3 and included operative time, warm ischemia time, estimated blood loss, and length of hospital stay.ResultsCompared with RDN, LDN had shorter operative time (min; weighted mean difference (WMD): −0.53; 95% CI: [−0.85, 0.20]; P = 0.001) and warm ischemia time (second; WMD: −55.01; 95% CI: [−71.56, 38.45]; P < 0.00001) and less estimated blood loss (mL; WMD: −28.30, 95% CI: [−46.37, 10.24], P = 0.002). The pooled analysis of postoperative pain showed lower visual analog scale (VAS) scores for RDN compared with LDN (WMD:1.28, P < 0.00001). We also observed that length of hospital stay, postoperative serum creatinine (SCr) in donors, postoperative estimated glomerular filtration rate (eGFR) of recipients and postoperative complications for donors were not significantly different between groups.ConclusionAs long as RDN is practiced proficiently, it is believed that RDN is a feasible alternative to LDN.

Robot-Assisted versus Laparoscopic Donor Nephrectomy: A Comparison of 250 Cases

“…Concerning the primary outcomes, operating time was no different between RDN and LDN (223.5 vs. 213 min, see Table 1 ). Most studies describe shorter operating times for LDNs, but report highly variable results [ 17 ]. Mean operating times for RDNs range from 144 to 306 min [ 23 , 24 ], and for LDNs between 178 and 270 min [ 25 , 26 ], even when only studies with cohorts larger than 100 patients are included.…”

“…In the RDNs, most grafts were extracted via a GelPOINT ® trocar (Applied Medical, Los Angeles, CA, USA), which is an easy and fast, yet expensive method. Wang et al illustrated significantly longer WIT for RDNs than LDNs in their meta-analysis, which is an often-stated argument against RDNs [ 17 , 30 ]. However, it is unlikely that differences of 30 or 60 s in WIT will harm the graft function in the long-, mid- or even short-term.…”

“…Importantly, LDN is not inferior in terms of complication rates, short- and long-term graft function. On the other hand, when comparing LDN with the robotic approach, RDN appears to have even less postoperative pain and less blood loss, but a longer WIT and operating time [ 17 ]. Nonetheless, analyses of cohorts with big sample sizes are still lacking, and the high variability of minimally-invasive DN renders it difficult to draw direct conclusions.…”

Nefrectomía laparoscópica en un programa de donante vivo en la Costa Caribe de Colombia

“…Una cohorte de 507 nefrectomías por laparoscopia via retroperitoneal reporto menor tiempo en isquemia caliente sin requerimiento de manipulación intraperitoneal 8 . La nefrectomía laparoscópica robot-asistida también ha presentado un auge importante, aunque requiere el debido y correcto entrenamiento 9 . Del mismo modo, se están realizando diferentes protocolos peri, intra y posoperatorios para mejorar los resultados de la nefrectomía por laparoscopia como por ejemplo, el uso de anestesia epidural posoperatoria 10 .…”

Die ersten 50 roboterassistierten Donornephrektomien

“…Beim direkten Vergleich von LDN und RDN ist die Evidenz geringer mit bisher nur zwei prospektiven, randomisiert kontrollierten Studien [3,20]. Es wird häufig angeführt, die RDN habe noch weniger postoperative Schmerzen und weniger Blutverlust, aber längere Operations-und WIZ [28].…”