EURURO Vol. 72 No. 2

Platinum Priority – Renal Disease

Editorial by Antonio Alcaraz, Lluis Peri, Laura Izquierdo and Mireia Musquera on pp. 218–219 of this issue

Minimally Invasive, Laparoscopic, and Robotic-assisted

Techniques Versus Open Techniques for Kidney Transplant

Recipients: A Systematic Review

Sven Wagenaar

a , b , * ,

Johanna

[15_TD$DIFF]

H. Nederhoed

[14_TD$DIFF]

[16_TD$DIFF]

Arjan W.J. Hoksbergen

a ,

H. Jaap Bonjer

a ,

Willem Wisselink

a ,

Gabrielle H. van Ramshorst

a , c

Department of Surgery, VU Medical Center, Amsterdam, The Netherlands;

Department of Urology, Meander Medical Centre, Amersfoort, The Netherlands;

Department of Surgery, Dutch Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 2 0 5 – 2 1 7

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

Article info

Article history:

Accepted February 9, 2017

Associate Editor:

Giacomo Novara

Keywords:

Minimally invasive surgery

Laparoscopic surgery

Robotic-assisted surgery

Open surgery

Kidney transplant recipients

Abstract

Context:

Literature on conventional and minimally invasive operative techniques has

not been systematically reviewed for kidney transplant recipients.

Objective:

To systematically evaluate, summarize, and review evidence supporting

operating technique and postoperative outcome for kidney transplant recipients.

Evidence acquisition:

A systematic reviewwas 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.

Evidence synthesis:

Included reports described conventional open, minimally invasive

open, laparoscopic, and robotic-assisted techniques. General level of evidence of in-

cluded 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.

Conclusions:

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.

Patient summary:

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.

* Corresponding author. Department of Surgery, VU Medical Center, Boelelaan 1118, 1081 HZ

Amsterdam, The Netherlands. Tel. +31 20 4444444/+31 6 51919735.

E-mail addresses:

svenwagenaar@gmail.com , s.wagenaar@vumc.nl

(S. Wagenaar).

http://dx.doi.org/10.1016/j.eururo.2017.02.020

0302-2838/