The impact of laparoscopic nephrectomy on patient outcome: a community perspective

Despite laparoscopic nephrectomy now being established as the favored technique for extirpative renal surgery, adoption of the technique is not universal, particularly in the community setting. We describe our experience with establishing a laparoscopic program in a regional hospital and the benefits that have accrued to our community as a result.

We performed a retrospective review of all patients undergoing nephrectomy in Geelong during the 10-year period that spanned the introduction of the laparoscopic approach. Patients were divided into two groups based on the timing of their surgery in relation to the first attempted laparoscopic nephrectomy in Geelong-"prelaparoscopic" (n = 129) or "postlaparoscopic" (n = 208). In the latter group, this was regardless of the actual approach used. Demographic, clinical, and operative details were recorded and compared between the two groups.

Since the first attempt in 2001, the number of laparoscopic nephrectomies has increased annually, such that now 56% of all nephrectomies are performed via this approach. In the prelaparoscopic and postlaparoscopic groups, 73% and 78% of nephrectomies were performed for malignancy, respectively; the remainder were performed for a variety of benign conditions or trauma. Since the introduction of laparoscopy, the mean operative time for nephrectomy has increased by 1 hour (141 vs 201 min, P < 0.001), mean length of stay has decreased by 3.9 days (12 vs 8.1 d, P < 0.002), and the incidence of both minor and major complications has fallen (P < 0.05).

The introduction of laparoscopic nephrectomy results in significant benefits to the community by reducing cohort morbidity and length of stay.