title: Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients: A Systematic Review.
abstract: Literature on conventional and minimally invasive operative techniques has not been systematically reviewed for kidney transplant recipients.
  
  
  
  To systematically evaluate, summarize, and review evidence supporting operating technique and postoperative outcome for kidney transplant recipients.
  
  
  
  A systematic review was conducted in PubMed-Medline, Embase, and Cochrane Library between 1966 up to September 1, 2016, according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Articles were included and scored by two independent reviewers using Group Reading Assessment and Diagnostic Evaluation (GRADE), Newcastle-Ottawa Quality Assessment Scale (NOS), and Oxford guidelines for level of evidence. Main outcomes were graft survival, surgical site infection, incisional hernia, and cosmetic result. In total, 18 out of 1954 identified publications were included in this analysis.
  
  
  
  Included reports described conventional open, minimally invasive open, laparoscopic, and robotic-assisted techniques. General level of evidence of included studies was low (GRADE: 1-3; NOS: 0-4; and Oxford level of evidence: 4-2). No differences in graft or patient survival were found. For open techniques, Gibson incision showed better results than the hockey-stick incision for incisional hernia (4% vs 16%), abdominal wall relaxation (8% vs 24%), and cosmesis. Minimally invasive operative recipient techniques showed lowest surgical site infection (range 0-8%) and incisional hernia rates (range 0-6%) with improved cosmetic result and postoperative recovery. Disadvantages included prolonged cold ischemia time, warm ischemia time, and total operation time.
  
  
  
  Although the level of evidence was generally low, minimally invasive techniques showed promising results with regard to complications and recovery, and could be considered for use. For open surgery, the smallest possible Gibson incision appeared to yield favorable results.
  
  
  
  In this paper, the available evidence for minimally invasive operation techniques for kidney transplantation was reviewed. The quality of the reviewed research was generally low but suggested possible advantages for minimally invasive, laparoscopic, and robot-assisted techniques.
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Urology, Meander Medical Centre, Amersfoort, The Netherlands. Electronic address: svenwagenaar@gmail.com.
authors.forename: Sven
authors.initials: S
authors.lastname: Wagenaar
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Johanna H
authors.initials: JH
authors.lastname: Nederhoed
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Arjan W J
authors.initials: AWJ
authors.lastname: Hoksbergen
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: H Jaap
authors.initials: HJ
authors.lastname: Bonjer
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Surgery, Dutch Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Gabrielle H
authors.initials: GH
authors.lastname: van Ramshorst
mesh_terms: D002921:Cicatrix / Q000209:etiology; D050377:Cold Ischemia; D006085:Graft Survival; D006801:Humans; D000069290:Incisional Hernia / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D061646:Operative Time; D017060:Patient Satisfaction; D020127:Recovery of Function; D062707:Return to Work; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia
keywords: Kidney transplant recipients; Laparoscopic surgery; Minimally invasive surgery; Open surgery; Robotic-assisted surgery