Enchanced recovery after simple laparoscopic nephrectomy.

Abstract

Introduction. Simple nephrectomy is used for non-cancer diseases. That is, when the preservation of the kidney is unreasonable or dangerous. Since simple nephrectomy is a typical organ-delivering surgery, it is possible to optimize the perioperative period to reduce hospitalization and disability. The aim of the study was to compare the outcomes of simple laparoscopic nephrectomy using the enchanted recovery protocol and the standard approach. Materials and methods. A prospective randomized multicenter study included 27 patients with an established diagnosis of a non-functioning kidney, who were treated in the period 2018–2021 in urological hospitals in the city of Irkutsk. All patients were divided into two comparison groups: STANDART group (group I, n=14) and ENCHANCED RECOVERY group (group II, n=13). Results. Primary efficacy was comparable (p=0.892). It was found that the level of complications of class III according to Clavien-Dindo was statistically comparable in both groups (p>0.05), and the level of complications of class II was significantly higher in group I (p<0.05). When comparing the duration of hospitalization, there is a significantly (p <0.001) longer stay of patients in group I (9.5±2.2 days) compared to group II (1.0±0.0 days). Subjective satisfaction with the treatment performed (upon requesting a critical analysis of all possible complaints) was comparable and amounted to 57.1% for group I and 100% for group II (p=0.342). When conducting a logistic regression analysis for postoperative febrile condition, according to multivariate regression, the volume of intraoperative infusion was found to be a significant predictor (for each +1 ml; OR 0.003; 95% CI 0.0001; 0.005; p = 0.042); for postoperative pain syndrome >5 VAS points – increase in the size of the surgical approach per 1 mm (OR 0.14; 95% CI -0.01; 0.307; p = 0.077); for satisfaction with treatment, a negative effect of the duration of the postoperative stay was found (for each +1 day; OR -1.08; 95% CI -2.32; 0.15; p = 0.086). Conclusion. Simple laparoscopic nephrectomy under the enchanted recovery protocol allows achieving similar treatment results without increasing the risk of readmission or reoperation, but with the achievement of a better subjective and objective postoperative status of the patient.