The impact of minimally invasive techniques on open partial nephrectomy: a 10-year single institutional experience

With the advent of minimally invasive, nephron sparing surgical options we hypothesized that the indications, perioperative parameters and complication rates of open partial nephrectomy may have changed significantly during a 10-year period.

Open partial nephrectomy was compared during 2, 3-year periods. From 1994 to 1996 (before laparoscopic partial nephrectomy, cryoablation and radio frequency ablation) 208 cases were compared vs 347 open partial nephrectomies performed from 2004 to 2006 with regard to indications, perioperative parameters and complication rates.

There were no significant differences between the groups with regard to age (59 vs 58 years), gender (65.5% vs 65.0% male) and tumor size (3.9 vs 3.6 cm). Tumors removed in the recent era were more often in a solitary kidney (40.0% vs 15.6%) and centrally located (55.6% vs 37.3%), and pathological evaluation more often revealed higher grade (Fuhrman 3 or 4) (43.1% vs 27.8%, each p <0.0001). Despite increased technical difficulty ischemia time in the more recent era was shorter (19.1 vs 40.6 minutes, p = 0.0000), and the urological and overall complication rates were statistically similar (7.5% vs 8.9%, p = 0.6071 and 19.1% vs 14.4%, p = 0.1723, respectively).

At a tertiary referral center the introduction of minimally invasive, nephron sparing surgical techniques has drawn away less complicated, less aggressive tumors, reserving the bulk of more complicated central tumors for open partial nephrectomy without decreasing the total number of open cases. With experience these more difficult central tumors are being successfully treated with decreased warm ischemia time and complication rates that are comparable to those in historical series.