title: Laparoendoscopic single-site donor nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy.
abstract: BACKGROUND
  Advances in minimally invasive surgery for live kidney donors have led to the development of laparoendoscopic single site donor nephrectomy (LESS-DN). At present, laparoscopic donor nephrectomy is the technique of choice for donor nephrectomy globally. Compared with open surgical approaches, laparoscopic donor nephrectomy is associated with decreased morbidity, faster recovery times and return to normal activity, and shorter hospital stays. LESS-DN differs from standard laparoscopic donor nephrectomy; LESS-DN requires a single incision through which the procedure is performed and donor kidney is removed. Previous studies have hypothesised that LESS-DN may provide additional benefits for kidney donors and stimulate increased donor rates.
  
  
  OBJECTIVE
  This review looked at the benefits and harms of LESS-DN compared with standard laparoscopic nephrectomy for live kidney donors.
  
  
  METHODS
  We searched the Cochrane Kidney and Transplant's Specialised Register to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review.
  
  
  METHODS
  We included randomised controlled trials (RCTs) that compared LESS-DN with laparoscopic donor nephrectomy in adults.
  
  
  METHODS
  Three authors independently assessed studies for eligibility and conducted risk of bias evaluation. Summary estimates of effect were obtained using a random-effects model and results were expressed as risk ratios (RR) or risk difference (RD) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.
  
  
  RESULTS
  We included three studies (179 participants) comparing LESS-DN with laparoscopic donor nephrectomy. There were no significant differences between LESS-DN and laparoscopic donor nephrectomy for mean operative time (2 studies, 79 participants: MD 6.36 min, 95% CI -11.85 to 24.57), intra-operative blood loss (2 studies, 79 participants: MD -8.31 mL, 95% CI -23.70 to 7.09), or complication rates (3 studies, 179 participants: RD 0.05, 95% CI -0.04 to 0.14). Pain scores at discharge were significantly less in the LESS-DN group (2 studies, 79 participants: MD -1.19, 95% CI -2.17 to -0.21). For all other outcomes (length of hospital stay; length of time to return to normal activities; blood transfusions; conversion to another form of surgery; warm ischaemia time; total analgesic requirement; graft loss) there were no significant differences observed.Although risk of bias was assessed as low overall, one study was assessed at high risk of attrition bias.
  
  
  CONCLUSIONS
  Given the small number and size of included studies it is uncertain whether LESS-DN is better than laparoscopic donor nephrectomy. Well designed and adequately powered RCTs are needed to better define the role of LESS-DN as a minimally invasive option for kidney donor surgery.
authors.affiliation: Department of Urology, University Hospital Wales, Heath Park, Cardiff, UK, CF14 4XW.
authors.forename: Ameet
authors.initials: A
authors.lastname: Gupta
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Howard G
authors.initials: HG
authors.lastname: Kynaston
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Piotr L
authors.initials: PL
authors.lastname: Chlosta
authors.forename: Omar M
authors.initials: OM
authors.lastname: Aboumarzouk
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain; D016032:Randomized Controlled Trials as Topic; D060053:Transplant Donor Site