Laparoscopic Nephrectomy: A Prospective, Nonrandomized Comparison With Open Surgical Nephrectomy.

Abstract

Objective: To comparatively study the effectiveness of Laparoscopic nephrectomy vis-à-vis Open nephrectomy in patients of benign non functioning kidney and early stage renal cell carcinoma. It was a prospective, non-randomized study. Patients and Methods: 160 patients underwent open (n=80) or laparoscopic nephrectomy (n=80).The comparison was made in relation to the operative time, intra-operative and postoperative complications, blood loss and transfusions, pain and analgesia requirements, hospital stay and convalescence. Results: The mean operative time (96 minutes Vs 74 minutes) was more in the laparoscopic group. The mean blood loss (127 ml Vs 104 ml) was more in the open group. The resumption of oral intake (30.3 hours Vs 33.6 hours) and removal of drain (2.35 days Vs 2.6 days) was earlier in the laparoscopic group. Intra-operative complications were more in laparoscopic group (5% Vs 2.5%). A total of 4 patients (5%) had to be converted to open because of failure to progress, and bleeding due to major vessel injury. Post operative complications were significantly more in open group. Mean hospital stay in open group was 6.3 ± 1.34 days, significantly more than laparoscopic group of 4.2 ± 1.22 days. Tumor recurrence was seen in both the groups. Conclusion: Laparoscopic nephrectomy for benign and early stage malignant disease is superior to open surgery in terms of reduced blood loss, postoperative complications, hospital stay and cosmetic outcome. The accumulated follow-up oncological data has shown equal oncological efficacy of laparoscopic radical nephrectomy and the results are comparable to open radical nephrectomy.