Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark.
Eur Urol Focus. 2022 Nov;8(6):1795-1801. doi: 10.1016/j.euf.2022.03.021. Epub 2022 Apr 22.
The use of living kidney donors is increasing and there are several surgical approaches for donor nephrectomy but it remains unknown which procedure is optimal for the patient and the graft.
To review different surgical techniques for living donor nephrectomy and compare complication rates, warm ischemia time, and delayed graft function.
A systematic review of prospective studies involving surgical complications following living donor nephrectomy was conducted in the MEDLINE/PubMed and EMBASE databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Baseline data, perioperative and postoperative parameters, and postoperative complications are reported. Overall complication rates between surgical techniques were compared via analysis of variance with post hoc analysis. We included 35 studies involving 6398 patients and representing six different surgical procedures for living donor nephrectomy.
Hand-assisted laparoscopic donor nephrectomy had a significantly higher overall complication rate compared to open, laparoscopic, retroperitoneoscopic, and laparoendoscopic single-site techniques (p < 0.005). The complication rates were low and no mortality was observed. The main limitation was varying reporting of complications, with only one-third of the studies using the Clavien-Dindo classification.
No specific surgical approach seems superior in terms of complications, which were generally low. Different factors such as warm ischemia time, blood loss, and surgeon expertise define which surgical approach should be chosen.
We looked at the different surgical methods for removing the kidney from a living kidney donor. Overall, the different surgical techniques were similar in terms of complications and no donors died in the studies we reviewed. The choice of procedure depends on multiple factors such as the expertise of the surgeon and the surgical center.
活体供肾者的使用正在增加，并且有几种用于供肾切除术的手术方法，但仍不清楚哪种方法对患者和移植物最佳。
回顾活体供肾切除术的不同手术技术，并比较并发症发生率、热缺血时间和移植物功能延迟。
根据系统评价和荟萃分析报告的首选报告项目 (PRISMA-P)，在 MEDLINE/PubMed 和 EMBASE 数据库中对涉及活体供肾切除术后手术并发症的前瞻性研究进行了系统评价。报告了基线数据、围手术期和术后参数以及术后并发症。通过方差分析和事后分析比较了手术技术之间的总体并发症发生率。我们纳入了 35 项研究，涉及 6398 名患者，代表了活体供肾切除术的六种不同手术方法。
与开放、腹腔镜、后腹腔镜和腹腔镜单部位技术相比，手助腹腔镜供肾切除术的总体并发症发生率明显更高（p < 0.005）。并发症发生率低，未观察到死亡。主要限制是并发症报告存在差异，只有三分之一的研究使用了 Clavien-Dindo 分类。
在并发症方面，没有一种特定的手术方法似乎具有优势，而并发症通常较低。不同的因素，如热缺血时间、失血量和外科医生的专业知识，决定了应选择哪种手术方法。
我们研究了从活体供肾者身上取出肾脏的不同手术方法。总的来说，我们回顾的研究中，不同的手术技术在并发症方面相似，没有供者死亡。手术方法的选择取决于多个因素，如外科医生和手术中心的专业知识。
