LAUSR

INTRODUCTION Staplers and nontransfixion techniques (polymer locking and metal clips) are the methods employed to secure the renal vessels during laparoscopic and robotic living donor nephrectomy (LDN), but the use of clips has come into question since the FDA and manufacturers issued a contraindication. METHODS A systematic review and meta-analysis were conducted to assess the safety of vascular closure devices (PROSPERO registration: CRD42022364349). The PubMed, Scopus, EMBASE, and LILACS databases were searched in September 2022. For comparative and noncomparative studies, incidence estimates and odds ratios, respectively, for the main variables regarding safety of vascular closure devices were pooled by using random effects meta-analyses. Quality assessment of the included comparative studies was conducted using the ROBINS-I tool. RESULTS Of the 863 articles obtained, data were retrieved from 44 studies, which included 42,902 patients. In noncomparative studies, the pooled estimate rates for device failure, severe hemorrhage rate, conversion to open surgery, and mortality were similar for both clips and staplers. Regarding the meta-analyses for comparative studies (3 studies), there were no significant differences between the two groups with respect to severe hemorrhage rate (OR 0.57, 95%CI 0.18-1.75; p=0.33), conversion to open surgery (OR 0.35, 95%CI 0.08-1.54; p=0.16), or death rate (OR 3.64, 95%CI 0.47-28.45; p=0.22). Based on weak evidence, device failure was lower in the polymer clip group (OR 0.41; 95%CI 0.23-0.75; p=0.00). CONCLUSIONS This study has confirmed that there is no evidence for the superiority of any vascular closure device in terms of safety in LDN. Standardized recommendations for vascular control in this context should be carefully designed and prospectively evaluated.