title: A comparison of technique modifications in laparoscopic donor nephrectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare the effectiveness of different technique modifications in laparoscopic donor nephrectomy.
  
  
  METHODS
  Systematic review and meta-analyses.
  
  
  METHODS
  Searches of PubMed, EMBASE, Web of Science and Central from January 1st 1997 until April 1st 2014.
  
  
  METHODS
  All cohort studies and randomized clinical trials comparing fully laparoscopic donor nephrectomy with modifications of the standard technique including hand-assisted, retroperitoneoscopic and single port techniques, were included.
  The primary outcome measure was the number of complications. Secondary outcome measures included: conversion to open surgery, first warm ischemia time, estimated blood loss, graft function, operation time and length of hospital stay. Each technique modification was compared with standard laparoscopic donor nephrectomy. Data was pooled with a random effects meta-analysis using odds ratios, weighted mean differences and their corresponding 95% confidence intervals. To assess heterogeneity, the I2 statistic was used. First, randomized clinical trials and cohort studies were analyzed separately, when data was comparable, pooled analysis were performed.
  
  
  RESULTS
  31 studies comparing laparoscopic donor nephrectomy with other technique modifications were identified, including 5 randomized clinical trials and 26 cohort studies. Since data of randomized clinical trials and cohort studies were comparable, these data were pooled. There were significantly less complications in the retroperitoneoscopic group as compared to transperitoneal group (OR 0.52, 95%CI 0.33-0.83, I2 = 0%). Hand-assisted techniques showed shorter first warm ischemia and operation times.
  
  
  CONCLUSIONS
  Hand-assistance reduces the operation and first warm ischemia times and may improve safety for surgeons with less experience in laparoscopic donor nephrectomy. The retroperitoneoscopic approach was significantly associated with less complications. However, given the, in general, poor to intermediate quality and considerable heterogeneity in the included studies, further high-quality studies are required.
  
  
  BACKGROUND
  The review protocol was registered in the PROSPERO database before the start of the review process (CRD number 42013006565).
authors: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Denise M D
authors: DM
authors: Özdemir-van Brunschot
authors: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Giel G
authors: GG
authors: Koning
authors: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Kees C J H M
authors: KC
authors: van Laarhoven
authors: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Mehmet
authors: M
authors: Ergün
authors: Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Sharon B C E
authors: SB
authors: van Horne
authors: Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Maroeska M
authors: MM
authors: Rovers
authors: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Michiel C
authors: MC
authors: Warlé
mesh_terms: D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic