Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease

We report the results from a nonrandomized comparison of open flank versus laparoscopic nephrectomy in patients with benign renal disease.

From January 1993 to December 1997, 249 nephrectomies for benign renal disease were performed at our institution. There were 118 patients in the open flank nephrectomy group (median age 58.5, range 8-89 years) and 131 patients in the laparoscopic nephrectomy group (median age 40, range 16-73 years). Clinical parameters such as operative times, blood loss, transfusion rates, conversion and complication rates, start of oral intake, analgesic consumption, duration of hospitalization and convalescence and short-term mortality were compared among both groups.

Median operative time in the open flank nephrectomy group was 90 (range 30-240) min and also 90 (range 41-210) min in the laparoscopic nephrectomy group. In the laparoscopy group 8 patients were converted to open surgery (6.1%). There were 27 complications (20.6%) in the laparoscopic nephrectomy group compared to 30 complications (25.4%) in the open flank nephrectomy group. Postoperatively, patients in the laparoscopic nephrectomy group required less morphine sulfate equivalent (12 vs. 20 mg) for pain control and they had a shorter hospital stay (4 vs. 10 days) and convalescence (24 vs. 36 days). The postoperative parameters are given as medians and reached statistically significant differences in favor of laparoscopic nephrectomy.

Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. As a matter of fact laparoscopy in urology is still a center-related procedure and even in these centers only a minority of urologists practice laparoscopy. However, in experienced centers the laparoscopic technique should be offered to patients with benign renal disease who are scheduled for elective nephrectomy.