Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients: A Systematic Review

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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 review was 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 included 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.

Original languageEnglish
Pages (from-to)205-217
Number of pages13
JournalEuropean Urology
Volume72
Issue number2
DOIs
Publication statusPublished - 1 Aug 2017

Cite this

@article{2c5cb309c27f4386b17368fc1dde9a27,
title = "Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients: A Systematic Review",
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 review was 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 included 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.",
keywords = "Kidney transplant recipients, Laparoscopic surgery, Minimally invasive surgery, Open surgery, Robotic-assisted surgery",
author = "Sven Wagenaar and Nederhoed, {Johanna H.} and Hoksbergen, {Arjan W.J.} and Bonjer, {H. Jaap} and Willem Wisselink and {van Ramshorst}, {Gabrielle H.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1016/j.eururo.2017.02.020",
language = "English",
volume = "72",
pages = "205--217",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients

T2 - A Systematic Review

AU - Wagenaar, Sven

AU - Nederhoed, Johanna H.

AU - Hoksbergen, Arjan W.J.

AU - Bonjer, H. Jaap

AU - Wisselink, Willem

AU - van Ramshorst, Gabrielle H.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - 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 review was 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 included 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.

AB - 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 review was 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 included 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.

KW - Kidney transplant recipients

KW - Laparoscopic surgery

KW - Minimally invasive surgery

KW - Open surgery

KW - Robotic-assisted surgery

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U2 - 10.1016/j.eururo.2017.02.020

DO - 10.1016/j.eururo.2017.02.020

M3 - Review article

VL - 72

SP - 205

EP - 217

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 2

ER -