title: Should hand-assisted retroperitoneoscopic nephrectomy replace the standard laparoscopic technique for living donor nephrectomy? A meta-analysis.
abstract: OBJECTIVE
  We performed this meta-analysis to compare hand-assisted retroperitoneoscopic (HARP) and traditional laparoscopic (TLS) techniques for living donor nephrectomy.
  
  
  METHODS
  We searched PubMed, Cochrane Central, EMBASE, and Web of science for prospective studies, comparing HARP and TLS techniques. Data were extracted from eligible studies and pooled as risk ratios (RR) or standardized mean difference (SMD), using RevMan software (version 5.3 for windows). We performed a sensitivity analysis to test the robustness of our evidence and a subgroup analysis to stratify intraoperative complications on Clavien-Dindo score.
  
  
  RESULTS
  Seven studies (498 patients) were included in the final analysis. HARP was superior to TLS in terms of shortening the operative duration (SMD = -0.84, 95% CI [-1.18 to -0.50]) and warm ischemia time (SMD = -0.93, 95% CI [-1.13 to -0.72]). There was no significant difference between HARP and TLS in terms of blood loss (SMD = 0.13, 95% CI [-0.50 to 0.76]), hospital stay (SMD = -0.27, 95% CI [-0.70 to 0.15]) or graft survival (RR = 0.97, 95% CI [0.92 to 1.02]). The overall risk ratio of intraoperative complications did not differ significantly between the two groups (RR = 0.62, 95% CI [0.31 to 1.21]).
  
  
  CONCLUSIONS
  Our meta-analysis shows that HARP was associated with a shorter surgery duration and less warm ischemia time than TLS. However, no significant differences were found between the two groups in terms of graft survival or intraoperative complication rates. We recommend HARP over TLS for living donor nephrectomy; however, future studies with larger sample sizes are recommended to compare both techniques in terms of operative safety and quality of life outcomes.
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt; NovaMed Medical Research Association, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elmaraezy
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt; Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt. Electronic address: Abdelrahman.abushouk@med.asu.edu.eg.
authors.forename: Abdelrahman Ibrahim
authors.initials: AI
authors.lastname: Abushouk
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt.
authors.forename: Moaz
authors.initials: M
authors.lastname: Kamel
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Zagazig University, El-Sharkia, Egypt; Student Research Unit, Zagazig University, El-Sharkia, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Negida
authors.affiliation: Urological Surgery Department, West Wales General Hospital, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Naser
mesh_terms: D005260:Female; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011788:Quality of Life; D020858:Tissue and Organ Harvesting
keywords: Kidney transplantation; Laparoscopy; Living donor; Nephrectomy