Comparison of hand-assisted laparoscopy versus open and laparoscopic techniques in urology procedures: A systematic review and meta-analysis

Background and Purpose: Hand-assisted laparoscopic surgery (HALS) is an integral part of the urologist's armamentarium. We aimed to perform a comprehensive meta-analysis comparing HALS renal surgery with open and laparoscopic techniques. Methods: A systematic review and meta-analysis of HALS renal procedures (donor nephrectomy, nephrectomy, or nephroureterectomy) from 1996 to 2007 was performed. Results: Sixty-two studies of 30 donor nephrectomy, 21 radical nephrectomy, and 14 nephroureterectomy procedures in 5446 patients were included in the analysis. In donor nephrectomy, estimated blood loss (EBL) was statistically significant for HALS vs the open and laparoscopic cohorts,-69.0mL (95% confidence interval [CI],-129.7,-8.2) and-40.1mL (95% CI,-68.2,-12.0), respectively. Length of stay (LOS) was shorter compared with the open group,-1.7 days (95% CI,-2.3,-1.1). For nephroureterectomy, EBL (-29.9mL (95% CI,-242.3, 182.5)), and LOS (-1.5 d [95% CI,-2.8,-0.3]) again favored HALS vs open procedures. Operating room (OR) time and warm ischemia time (WIT) were statistically significant in favor of HALS donor nephrectomy vs the laparoscopic cohort;-36.8 minutes (95% CI,-61.3,-12.3) and-1.3 minutes (95% CI,-1.8,-0.7), respectively. For radical nephrectomy, both EBL-232.9mL (95% CI,-383.6,-82.2) and LOS-2.4 days (95% CI,-3.5,-1.3) were statistically significant, favoring HALS vs the open group. Conclusion: We report the largest meta-analysis of HALS renal surgery to date. When compared with open surgery, HALS allows for a significant decrease in EBL and LOS. Compared with laparoscopic donor nephrectomy, HALS resulted in a significant decrease in blood loss, OR time, and WIT.