A Comparative Study Of Laparoscopic And Open Nephrectomy

Objective: To investigate the advantages of laparoscopic nephrectomy for benign nonfunctioning kidneys by comparing the clinical outcomes versus open surgery and to evaluate the clinical value of laparoscopic operation.Methods: We retrospectively reviewed 85 cases of simple nephrectomy from August 1997 to October 2007 in our hospital.Laparoscopic simple nephrectomy(LSN) was performed for 32 cases (23 lateralperitoneal approach and 9 retroperitoneal approach) ,and 53 patients with benign nonfunctioning kidneys underwent open nephrectomy during the same period.Clinical data including the operative time, intraoperative estimated blood loss, postoperative drainage volume,postoperative intestinal function recovery time,postoperative ambulation time,use of antalgesic,postoperative hospital stay and total cost of hospitalization were recorded and compared between the 2 groups.Results: All of the operations were successfully performed. There were no severe peri- or postoperative complications that could be related to the operations.In no instance did the laparoscopic procedure need to be converted to open surgery. In the LSN group,the operative time, estimated blood loss, postoperative drainage volume,postoprative intestinal function recovery time,postoperative ambulation time,postoperative hospital stay,total cost of hospitalization and use of antalgesic were (204.2±65.7)min,(52.5±24.5)ml,(39.1±10.3)hours,(78.6±35.3)ml,(59.4±13.1)hours, (7.4±1.3)days,(16468.0±4342.4)RMB and 3 cases respectively.And the datas in the open group were (105.1±34.1)min,(115.8±58.7)ml,(60.3±14.6)hours, (123.6±58.8)ml, (79.5±19.7)hours,(8.9±2.5)days,(10475.3±2571.1)RMB and 20 cases respectively. The intraoperative estimated blood loss, postoperative drainage volume,postoperative intestinal function recovery time,postoperative ambulation time,postoperative hospital stay and use of antalgesic in the LSN group were significantly less than them in the open group(P<0.05),while the operative time and the total cost of hospitalization were more than them in the open group(P<0.05).Conclusions: LSN has several advantages over open nephrectomy, namely a smaller wound, less blood loss, more rapid recovery and so on. We believe that these benefits outweigh the longer operative time and the higher hospital charges associated with the laparoscopic approach. It may provide a safe and effective method for resecting benign nonfunctioning kidneys.With time with repetition and experience and the development of laparoscopic techniques,the operative time and hospitalization cost in most LSN cases could be equal to open operations.