title: Determining the Superior Technique for Living-donor Nephrectomy: the Laparoscopic Intraperitoneal Versus the Retroperitoneoscopic Approach.
abstract: OBJECTIVE
  Laparoscopic living-donor nephrectomy is now widely used because of its many beneficial features. Currently, there are 2 major techniques: the laparoscopic intraperitoneal approach and the retroperitoneoscopic approach. There is no evidence to support one particular approach over another. Therefore, in this study, we conducted a systematic literature review with the aim of defining which technique is superior.
  
  
  METHODS
  The Embase, PubMed, and Cochrane literature databases were searched for English language articles published between January 1994 and January 2013 using the terms "laparoscopic donor nephrectomy," "retroperitoneoscopic donor nephrectomy," and "live donor nephrectomy." A meta-analysis was undertaken, and I(2) statistical analyses were used to describe the percentage of variation across studies due to heterogeneity rather than chance.
  
  
  RESULTS
  With the use of our selection criteria, 55 papers on the laparoscopic intraperitoneal approach and 6 papers on the retroperitoneoscopic approach were included in this study. We found significantly lower transfusion rate, fewer patients with delayed graft functions, less vessel injuries, and less conversion to open surgical procedure with the retroperitoneoscopic approach than with the laparoscopic intraperitoneal approach.
  
  
  CONCLUSIONS
  From this review, a high degree of study heterogeneity was identified, suggesting an urgent need for consistency in reporting laparoscopic living-donor nephrectomy. Results of the meta-analyses may define a better technique for the future. The retroperitoneoscopic approach may be better than the laparoscopic intraperitoneal approach with fewer complications and fewer patients with delayed graft function. Further study of laparoscopic living-donor nephrectomy is recommended to define a standard and thus to minimize the surgical morbidities.
authors.affiliation: From the WA Liver and Kidney Transplant Surgical Services, Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands 6009, Perth, Western Australia.
authors.forename: Bulang
authors.initials: B
authors.lastname: He
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bremner
authors.forename: Ying
authors.initials: Y
authors.lastname: Han
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Hamdorf
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome