Table 1.
Search strategy.
Fig 1.
PRISMA flow chart of study search [19].
Table 2.
Characteristics of randomized clinical trials.
Table 3.
Characteristics of cohort studies.
Table 4.
Risk of bias assessment for randomized clinical trials.
Table 5.
Quality assessment of cohort studies.
Fig 2.
Forrest plots comparing HALDN versus LDN (RCT’s and cohort studies combined).
a. Complications in HALDN versus LDN. Fourteen studies described the occurrence of complications in HALDN versus LDN (OR 0.75, 95% CI 0.46–1.24, I2 = 51%). b. Conversion to ODN in HALDN versus LDN. Eleven studies described the number of conversions to ODN in HALDN versus LDN (OR 0.61, 95% CI 0.30–1.25, I2 = 0%). c. WIT1 in HALDN versus LDN. Thirteen studies described WIT1 in HALDN versus LDN (MD -52.99, 95% CI -91.57- -14.41, I2 = 96%). WIT1 was significantly shorter for HALDN. d. EBL in HALDN versus LDN. Eight studies described EBL in HALDN versus LDN (MD -0.49, 95% CI -20.98–20.00, I2 = 59%). e. Graft function in HALDN versus LDN. Four studies described the incidence of delayed graft function in HALDN versus LDN (OR 0.49, 95% CI 0.10–2.32, I2 = 0%). f. ORT in HALDN versus LDN. Fourteen studies described ORT in HALDN versus LDN (MD -18.27, 95% CI -32.90- -3.64, I2 = 94%). ORT was significantly shorter in the HALDN group. f. LOS in HALDN versus LDN. Twelve studies described LOS in HALDN versus LDN (MD 0.22, 95% CI -0.34–0.77, I2 = 95%).
Fig 3.
Forrest plots comparing RDN versus LDN (RCT’s and cohort studies combined).
a. Complications of RDN versus LDN. Four studies compared complications in RDN versus LDN (OR 0.48, 95% CI 0.21–1.09, I2 = 23%, there was a tendency towards less complications for RDN. b. Conversion to ODN in RDN versus LDN. Three studies compared the number of conversions to ODN in RDN versus LDN (OR 0.75, 95% CI 0.15–3.68, I2 = 39%). c. WIT1 in RDN versus LDN. Three studies described WIT1 in RDN versus LDN (MD -50.77, 95%CI -132.59–31.04, I2 = 96%). d. EBL in RDN versus LDN. Three studies described EBL in RDN versus LDN (MD -5.38, 95% CI -43.13–32.37, I2 = 91%0. e. ORT in RDN versus LDN. Three studies described ORT in RDN versus LDN (MD -9.00, 95% CI -50.15–32.15, I2 = 95%). f. LOS in RDN versus LDN. Two studies described LOS in RDN versus LDN (MD -0.52, 95% CI -3.16–2.11, I2 = 82%).
Fig 4.
Forrest plots comparing HARDN versus LDN (RCT and cohort studies combined).
a. Complications of HARDN versus LDN. Four studies compared complications in HARDN versus LDN (ORT 0.59, 95% CI 0.31–1.10, I2 = 0%), there was a tendency towards less complications for HARDN. b. Conversion to ODN in HARDN versus LDN. Two studies compared the number of conversions to ODN in HARDN versus LDN (OR 0.37, 95%CI 0.04–3.70, I2 = 0%). c. WIT1 (seconds) in HARDN versus LDN. Three studies described WIT1 in HARDN versus LDN (MD -109.40, 95% CI-152.74- -66.06, I2 = 74%). HARDN was associated with shorter WIT1. d. ORT (minutes) in HARDN versus LDN. Three studies described ORT in HARDN versus LDN (MD -38.64, 95% CI -60.76- -16.53, I2 = 79%). HARDN was associated with shorter ORT.
Fig 5.
Forrest plots comparing LESS versus LDN (RCT and cohort studies combined).
a. Complications of LESS versus LDN. Five studies compared the number of complications in LESS versus LDN (OR 1.08, 95%CI 0.62–1.87, I2 = 0%). b. Conversion to ODN in LESS versus LDN. Two studies compared the number of conversion to ODN in LESS versus LDN (OR 1.17, 95%CI 0.06–23.59, I2 = 45%). c. WIT1 (seconds) in LESS versus LDN. Five studies described WIT1 in LESS versus LDN (MD 51.53, 95%CI -12.45–115.51, I2 = 94%). d. EBL (mL) in LESS versus LDN. Three studies described EBL in LESS versus LDN (MD -19.11, 95%CI 27.46 –-10.76, I2 = 0%). LESS was associated with significantly less EBL. e. ORT (minutes) in LESS versus LDN. Six studies compared ORT in LESS versus LDN (MD 19.78, 95% CI 8.87–30.69, I2 = 67%). ORT was significantly longer for LESS. f. LOS (days) in LESS versus LDN. Five studies compared LOS in LESS versus LDN (MD -0.07, 95% CI -0.41–0.27, I2 = 79%).
Fig 6.
Forest plot comparing the number of complications in the retroperitoneoscopic group (HARDN and RDN) versus the transperitoneal approach.
The number of complications was significantly lower in the retroperitoneoscopic group (OR 0.52, 95%CI 0.33–0.83, p<0.01).
Fig 7.
Forest plot comparing the number of complications in the hand-assisted versus the fully laparoscopic donor nephrectomy.
No difference in complications was found (OR 0.76, 95% CI 0.49–1.19, p = 0.23).
Fig 8.
8a: Forest plot comparing initial series of HALDN versus LDN (RCT and cohort studies combined).
Six studies were included. The initial series of HALDN were associated with less complications (OR 0.45, 95% CI 0.23–0.88, p = 0.02). 8b: Forest plot comparing recent series of HALDN versus LDN (RCT and cohort studies combined). Six studies were included, no association between number of complications and hand-assistance could be observed (OR 0.99, 95% CI 0.49–1.99, p = 0.98).
Table 6.
Complications and estimation of severity.
Fig 9.
9a: Funnel plot comparing complications in HALDN versus LDN.
9b. Funnel plot comparing complications in RDN versus LDN. 9c: Funnel plot comparing complications in HARDN versus LDN. 9d: Funnel plot comparing complications in LESS versus LDN. 9e: Funnel plot comparing complications in retroperitoneal versus transperitoneal approach. Studies at the bottom tend to cluster towards the right. 9f: Funnel plot comparing complications in hand-assisted versus fully laparoscopic approach.