Intraoperative ultrasonography (IOUS)-guided vs conventional laparoscopic nephrectomy: a randomised control trial

Area of Science:

• Urology
• Surgical Technology
• Medical Imaging

Background:

• Laparoscopic nephrectomy (LN) is a standard surgical procedure for kidney removal.
• Optimizing perioperative outcomes in LN remains a focus for improving patient care.
• Intraoperative ultrasonography (IOUS) is a tool that may enhance surgical precision.

Purpose of the Study:

• To evaluate the effectiveness of routine intraoperative ultrasonography (IOUS) in improving perioperative outcomes for patients undergoing IOUS-guided laparoscopic nephrectomy (IOUS-LN) compared to conventional laparoscopic nephrectomy (C-LN).
• To assess the impact of IOUS on operative duration, blood loss, and other key surgical metrics.

Main Methods:

• A parallel-arm, single-blinded, randomized controlled trial was conducted.
• 104 patients undergoing LN for benign or malignant causes were included.
• The study arm utilized IOUS for renal vascular assessment, while the control arm followed a standard LN procedure.

Main Results:

• Intraoperative ultrasonography-guided laparoscopic nephrectomy (IOUS-LN) significantly reduced operative duration compared to conventional laparoscopic nephrectomy (C-LN) (181.69 vs. 199.7 min, P=0.02).
• No significant difference in overall blood loss was observed between the groups (P=0.08).
• Subgroup analysis revealed significant reductions in operative duration (P=0.01) and blood loss (P=0.03) for patients undergoing laparoscopic simple nephrectomy (LSN) with IOUS.

Conclusions:

• Routine intraoperative ultrasonography (IOUS) effectively reduces operative duration in laparoscopic nephrectomy (LN).
• While IOUS did not significantly decrease overall blood loss, it showed benefits in reducing both operative time and blood loss for laparoscopic simple nephrectomy (LSN).
• IOUS did not influence outcomes in patients undergoing laparoscopic radical nephrectomy (LRN).