Intraoperative And Perioperative Results

In the world's literature, over 640 laparoscopic radical nephrectomies have been reported to date. The standard transperitoneal approach is the most commonly used technique, followed by hand-assisted, and lastly the retroperitoneoscopic method. Among the studies that have analyzed the operative results of laparoscopic radical nephrectomy (16-25), aEthicon Inc., Cincinnati, OH.

bApplied Medical Resources, Rancho Santa Margarita, CA.

TABLE2 ■ Comparison of Operative Results Between Laparoscopic Radical Nephrectomy and Open Radical Nephrectomy

Dunn et al. (16) Portis et al. (17) Chan et al. (18) Saika et al. (19) Makhoul et al. (20) Shuford et al. (21)

TABLE2 ■ Comparison of Operative Results Between Laparoscopic Radical Nephrectomy and Open Radical Nephrectomy

Dunn et al. (16) Portis et al. (17) Chan et al. (18) Saika et al. (19) Makhoul et al. (20) Shuford et al. (21)

Procedure

Lapa

Open

Lapb

Open

Lapc

Open

Lapd

Open

Lape

Open

Lapf

Open

Number

61

33

64

69

67

54

195

68

39

26

33

41

OR time (min)

330

168

287

128

256

193

275.7

203.1

134

133

-

-

Estimated blood

172

451

219

354

289

309

248.5

482.0

133

357

246

371

loss (mL)

Hospital stay (day)

3.4

5.2

4.8

7.4

3.8

7.2

-

-

5.5

8.8

1.7

3.6

Time to full convales-

25.2

56.7

-

-

-

-

22.7

58.7

-

-

-

-

cence (day)

Conversion rate (%)

1.6

-

-

-

1.5

-

3.6

-

-

-

3.3g

-

Tumor size (cm)

5.3

7.4

4.3

6.2

5.1

5.4

3.7

4.4

3.93

4.8

4.6

7.4

Stage

T1, T2,T3

pT1, pT2, pT3

T1,T2

pT1, pT2

T1,T2,T3

pT1, pT2

pT1

pT1

pT1

pT1

-

-

a55 transperitoneal, 3 retroperitoneal, and 3 combined transperitoneal and retroperitoneal laparoscopic radical nephrectomies.

b52 transperitoneal and 12 retroperitoneal laparoscopic radical nephrectomies.

c66 transperitoneal and 1 retroperitoneal laparoscopic radical nephrectomies.

d177 transperitoneal and 18 retroperitoneal laparoscopic radical nephrectomies.

eAll retroperitoneal laparoscopic radical nephrectomies.

f15 transperitoneal, 18 hand-assisted laparoscopic radical nephrectomies.

gConversion done electively for tumor extension into renal hilum.

Abbreviation: OR, operating room.

Table 2 summarizes the six studies that compared the results of laparoscopic radical nephrectomy with those of contemporary series of open radical nephrectomy.

Overall, it takes longer to complete laparoscopic radical nephrectomy than open radical nephrectomy. However, laparoscopy groups tended to have smaller estimated blood loss, shorter length of hospital stay, and lower amount of analgesic use.

The time to convalescence for laparoscopy ranged from 23 to 25 days whereas that of the open procedure ranged from 57 to 59 days. The conversion rate to an open procedure was 1.5% to 3.6%.

The cosmetic advantage of laparoscopy is also evident as it was recently reported that a flank bulge following a standard flank incision was detected in almost 50% of patients (26).

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