Laparoscopic nephrectomy: the learning-curve experience.

When patients are properly selected, laparoscopic neph rectomy provides decreased postoperative morbidity, a shorter convalescence, and thus cost savings, compared with open nephrectomy.

Abstract

OBJECTIVE: To report the learning-curve experience with laparoscopic nephrectomy. DESIGN: Case series. SETTING: A tertiary-care referral centre serving southern Saskatchewan. PATIENTS: Sixteen patients (7 men, 9 women), selected to undergo laparoscopic nephrectomy. They ranged in age from 19 to 83 years. Indications for surgery were: recurrent atrophic pyelonephritis with pain (three patients), obstruction at the ureteropelvic junction with pain (three), small ectopic kidney with pain (one), renovascular hypertension (two), a solid renal mass confirmed by computed tomography (four), Staghorn calculus (one), transitional cell tumour of upper ureter (one) and pyonephrosis with a nonfunctioning kidney (one). INTERVENTIONS: Laparoscopic nephrectomy. MAIN OUTCOME MEASURES: Postoperative morbidity, complications of the procedure and duration of postoperative hospitalization. RESULTS: Kidneys were removed laparoscopically in 13 patients. Open nephrectomy was necessary in three patients, owing to a lack of experience in patient selection in two cases and to intraoperative hemorrhage in the third. All patients resumed oral intake on the 1st postoperative day, and most did not require analgesics for relief of pain beyond 36 hours postoperatively. Complications of laparoscopic nephrectomy included pneumonia (one patient), low-grade fever (two patients), need for blood transfusion (three patients) and transient ischemic attack (one patient). The mean postoperative hospital stay was 4.3 days. CONCLUSIONS: When patients are properly selected, laparoscopic nephrectomy provides decreased postoperative morbidity, a shorter convalescence, and thus cost savings, compared with open nephrectomy.