A Review of the First 100 Cases of Laparoscopic Nephrectomy: A Single-Center Experience

Abstract

Since 1990, when the first laparoscopic nephrectomy was performed, there has been a dramatic increase in interest in laparoscopic procedures in urological surgeries. The aim of the study was to present our experience with the first 100 cases of laparoscopic nephrectomy at our institute, identify the difficulties encountered, and discuss how to approach the solutions. Materials and methodsThe data of all patients who underwent laparoscopic nephrectomy between May 2017 and April 2019 (n=100) were reviewed retrospectively. ResultsA total of 100 patients (49 men and 51 women), with a mean age of 34.1 ± 15.1 years, underwent laparoscopic nephrectomy. The mean operative time was 108 min (IQR, 45-240). The operative time was significantly reduced with the surgeons' experience. Of 100 cases, only four were converted to open surgery because of bleeding from the renal bed area, strong adhesions from previous surgeries, or morbid obesity. Of 100 patients, 30 were allowed intake on the same operative day while 70 were allowed on the first postoperative day. Intravenous and oral analgesics were discontinued on the second postoperative day in 81 patients. ConclusionThe learning curve in our series of cases is comparable to a very similar study with reduced operative time, reduced blood loss, and fewer complications when compared to open nephrectomy. In addition, setups with minimal previous laparoscopic units can initiate laparoscopic procedures with minimal risk to the patient.

Outcomes of initial 100 cases of laparoscopic nephrectomy at tertiary care center (PKLI)

“…Thirty-two percent of their cases had a prior history of abdominal surgery, such as appendectomy, C-section, or pyelolithotomy. 14 In the present study, 51.48% had laparoscopic nephrectomy on the right side and eighteen percent of the patients had a previous surgical history on the ipsilateral side.…”

“…Mithani et al had Very few complications; one percent of wound infections, one percent of prolonged ileus, while two percent cases required blood transfusion. 14 Similarly, Quddus et al reported majority complications being Clavien Grade-2 including 10% blood transfusion. 15 We categorized complications based on Clavien-Dindo classification: Grade 1 (n=3; 2.97%), Grade-2 (n=6; 5.94%), Grade-3A (n=1; 0.99%), and grade 3B (n=1; 0.99%) complications were observed ( Table-II ).…”

“…Laparoscopy offers less morbidity, improved operative precision and better cosmesis. 11 - 14 Several studies have reported shorter periods required for a return to full activity (three to four weeks) in contrast to 8 to 10 weeks that may be taken after open surgery. 13 - 16…”

“…15 In the present study, we had to convert seven cases to open surgery because of difficulty in the progression of the laparoscopic surgery or bleeding obscuring the view. Mithani et al 14 reported an operative time reaching 108 minutes, and Zaidi et al 16 shared their experience in performing laparoscopic nephrectomies in 60 patients with a mean operative time reaching 140 + 51.1 minutes. Quddus et al had a mean operative time of 216 ± 100 minutes.…”

“…Laparoscopy offers less morbidity, improved operative precision and better cosmesis. [11][12][13][14] Several studies have reported shorter periods required for a return to full activity (three to four weeks) in contrast to 8 to 10 weeks that may be taken after open surgery. [13][14][15][16] Mithani et al from Karachi shared their experience with initial 100 cases of laparoscopic nephrectomy.…”