Robotic-assisted versus laparoscopic living donor nephrectomy for renal transplantation: a systematic review and meta-analysis

Ann R Coll Surg Engl. 2023 Jan;105(1):7-13. doi: 10.1308/rcsann.2021.0357. Epub 2022 May 26.

Abstract

Introduction: Renal transplantation remains the definitive treatment for end-stage renal disease. Currently employed minimally invasive techniques include robotic-assisted laparoscopy and laparoscopy. This study aims to determine whether either method provides an advantage.

Methods: Following PRISMA guidelines, a systematic review was conducted. Data were analysed using Review Manager 5.3.

Results: A total of 12 studies were included. Operative time and operative bleeding were similar between both approaches, with a mean difference (MD) of 16min (95% confidence interval (CI) -4.06, 37.38; p = 0.11) and 10.44ml (95% CI -43.89, 64.78; p = 0.71), respectively. Robotics had longer warm ischemia time (MD 1.14min; 95% CI 0.65, 1.63; p = 0.00001) but reduced length of stay (LOS) (MD -0.23days; 95% CI -0.45, -0.01; p = 0.04) and pain (MD -1.26 VAS; 95% CI -1.77, 0.75). Similar complication and conversion rates were seen among groups.

Conclusions: Robotic approaches provide a viable alternative to laparoscopic surgery. Operative time, bleeding volumes, complications and conversion rates are similar between both techniques; apparent robotic advantages on LOS and Pain need to be better analysed by future studies.

Keywords: Donor nephrectomy; Renal transplantation.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Kidney Transplantation* / methods
  • Laparoscopy* / adverse effects
  • Laparoscopy* / methods
  • Living Donors
  • Nephrectomy / adverse effects
  • Nephrectomy / methods
  • Pain
  • Robotic Surgical Procedures* / adverse effects
  • Robotic Surgical Procedures* / methods
  • Treatment Outcome