Laparoendoscopic single-site versus conventional laparoscopic living donor nephrectomy: a systematic review and meta-analysis of randomized controlled trials

Background: Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain controversial. This meta-analysis aimed to compare the outcomes of LESS-DN and CLDN based on randomized controlled trials (RCTs). Methods: PubMed, Embase, and the Cochrane Library were searched up to August 20, 2025, for English-language RCTs comparing LESS-DN and CLDN. The risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1.0), and pooled analyses were performed using Review Manager 5.4.1 software. Results: Four randomized controlled trials involving 274 donors (LESS-DN, n = 136; CLDN, n = 138) were included. There were no significant differences between groups in operative time, warm ischemia time, estimated blood loss, length of hospital stay, time to extraction, or overall complication rates. Conclusions: Based on the currently available randomized evidence, no statistically significant differences were detected between LESS-DN and CLDN in the perioperative outcomes analyzed in living kidney donors. Further adequately powered, multicenter randomized trials—particularly evaluating postoperative pain, patient-reported recovery, and cosmetic satisfaction—are warranted. © The Author(s), under exclusive licence to Springer Nature B.V. 2026.