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awarded 2 or 3 points on the NOS, and level of evidence 4
(Oxford). Summary of assessment can be found in
and risk of bias assessment in Each article was
ranked by two authors (S.W. and G.H.V.R.) in one of three
groups describing the quality of evidence: low, interme-
diate, or high. The aforementioned RCT without a risk of
bias or other serious limitations was scored high; four
articles were scored intermediate and 13 articles low
A total of 18 included studies described 16 different
operative techniques, which were subdivided into four
groups: conventional open, minimally invasive open,
laparoscopic, and robotic-assisted techniques.
First, the conventional open kidney transplantation
(COKT) included open kidney transplantation through a
GIBI, described in three studies Four studies
reported on HSIs Another six studies described
COKT without specifications of techniques
.
Minimally invasive open kidney transplantation
(MIOKT) included studies in which open kidney transplan-
tation was performed through a small incision placed in the
Table 1 – Risk of bias and quality assessment of included articles
Author Technique Type of
evidence
GRADE Initial
grade
Downgraded
based on
Upgraded
based on
NOS LoE Conclusion
Nanni (2005) GIBI vs HSI Retrospective
cohort
1 2 Bias,
indirectness
None 2 4 Intermediate
Øyen (2006) COKT vs MIKT Retrospective
cohort
1 2 Bias,
indirectness
None 2 4 Low
Filocamo (2007) HSI vs MLI Retrospective
cohort
2 3 Inconsistency,
imprecision
Large
effects
3 3 Intermediate
Mun (2007) HSI vs MIVAKT Retrospective
cohort
1 2 Bias,
indirectness,
imprecision
None 1 4 Low
Park (2008) HSI vs MSI Case series 1 2 Bias,
inconsistency,
indirectness,
imprecision
None 0 4 Low
Brockschmidt (2012) COKT vs MAKT Case series 2 3 Bias None 3 4 Low
Kacar (2013) COKT vs MIKT Retrospective
cohort
1 2 Bias,
indirectness
None 3 4 Low
Malinka (2013) HSI vs STI Randomized
controlled trial
3 3 None None NA 2 High
Brockschmidt (2014) COKT vs MAKT Retrospective
cohort
1 3 Bias,
inconsistency,
indirectness
None 3 4 Low
Kishore (2014) GIBI vs MFI Retrospective
cohort
2 3 Bias,
indirectness
None 4 4 Intermediate
Kim (2016) MIKT vs COKT Retrospective
cohort
1 2 Bias None 4 3 Low
Modi (2013) GIBI vs LKT suprapubic incision Retrospective
cohort
2 3 Bias,
inconsistency
None 3 3 Intermediate
Modi (2015) COKT vs LKT transvaginal
insertion
Retrospective
cohort
1 3 Bias,
inconsistency,
indirectness
None 3 4 Low
Oberholzer (2013) GIBI vs RAKT paraumbilical
incision with transperitoneal
approach
Prospective
cohort
1 2 Bias,
indirectness
None 3 4 Low
Menon (2014) RAKT vertical paraumbilical
incision transperitoneal
approach
Case series 1 2 Bias None 3 4 Low
Tsai (2014) GIBI vs RAKT retroperitoneal
approach
Case series 1 2 Bias None 2 4 Low
Sood (2015) RAKT vertical paraumbilical
incision transperitoneal
approach
Case series 1 2 Bias None 2 4 Low
Tugcu (2016) RAKT vertical paraumbilical
incision transperitoneal
approach
Case series 1 2 Bias None 1 4 Low
NA = not applicable; GIBI = Gibson incision; HSI = hockey-stick incision; MLI = midline incision; COKT = conventional open kidney transplantation;
MIKT = minimally invasive kidney transplantation; MIVAKT = minimally invasive video-assisted kidney transplantation; MSI = modified skin incision;
MAKT = minimal-access kidney transplantation; MFI = modified Pfannenstiel incision; LKT = laparoscopic kidney transplantation; RAKT = robotic-assisted
kidney transplantation; GRADE = Group Reading Assessment and Diagnostic Evaluation; NOS = Newcastle–Ottawa Quality Assessment Scale; LoE = level of
evidence; STI = short transverse incision.
a Study quality based on GRADE scale .
b Study quality based on Newcastle–Ottawa Scale .
c Study quality based on Oxford levels of evidence .
d Quality of evidence within available literature.
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