Laparoendoscopic single‐site (LESS) vs laparoscopic living‐donor nephrectomy: a systematic review and meta‐analysis

The aim of this study was to provide a systematic review and meta‐analysis of reports comparing laparoendoscopic single‐site ( LESS ) living‐donor nephrectomy ( LDN ) vs standard laparoscopic LDN ( LLDN ). A systematic review of the literature was performed in S eptember 2013 using PubMed , S copus, O vid and The C ochrane library databases. Article selection proceeded according to the search strategy based on P referred R eporting I tems for S ystematic R eviews and M eta‐analyses criteria. Weighted mean differences ( WMDs ) were used to measure continuous variables and odds ratios ( ORs ) to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS LDN and 1006 LLDN cases. There were more left‐side cases in the LESS LDN group (96.5% vs 88.6%, P < 0.001). Meta‐analysis of extractable data showed that LLDN had a shorter operative time ( WMD 15.06 min, 95% confidence interval [ CI ] 4.9–25.1; P = 0.003), without a significant difference in warm ischaemia time ( WMD 0.41 min, 95% CI –0.02 to 0.84; P = 0.06). Estimated blood loss was lower for LESS LDN ( WMD −22.09 mL, 95% CI –29.5 to –14.6; P < 0.001); however, this difference was not clinically significant. There was a greater likelihood of conversion for LESS LDN ( OR 13.21, 95% CI 4.65–37.53; P < 0.001). Hospital stay was similar ( WMD –0.11 days, 95% CI –0.33 to 0.12; P = 0.35), as well as the visual analogue pain score at discharge ( WMD –0.31, 95% CI –0.96 to 0.35; P = 0.36), but the analgesic requirement was lower for LESS LDN ( WMD –2.58 mg, 95% CI –5.01 to –0.15; P = 0.04). Moreover, there was no difference in the postoperative complication rate ( OR 1.00, 95% CI 0.65–1.54; P = 0.99). Renal function of the recipient, as based on creatinine levels at 1 month, showed similar outcomes between groups ( WMD 0.10 mg/dL, –0.09 to 0.29; P = 0.29). In conclusion, LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional LLDN , with a lower analgesic requirement. However, it is more technically challenging than LLDN , as shown by a greater likelihood of conversion. The role of LESS LDN remains to be defined.