ReviewShould hand-assisted retroperitoneoscopic nephrectomy replace the standard laparoscopic technique for living donor nephrectomy? A meta-analysis

•We compared hand assisted retroperitoneoscopic (HARP) and traditional laparoscopic approaches for living donor nephrectomy.•Pooling data of 7 clinical trials showed that HARP was associated with shorter operative and warm ischemia times than TLS.•Intraoperative complications on Clavien-Dindo score were comparable between the two techniques.

ObjectiveWe performed this meta-analysis to compare hand-assisted retroperitoneoscopic (HARP) and traditional laparoscopic (TLS) techniques for living donor nephrectomy.MethodsWe 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.ResultsSeven 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]).ConclusionOur 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.