Retroperitoneoscopic nephrectomy for benign diseases of the kidney: Prospective nonrandomized comparison with open surgical nephrectomy

Purpose: To describe, define, and evaluate the efficacy of retroperitoneosc opic nephrectomy (RPN) for benign diseases of the kidney and to compare it with open surgical nephrectomy (OSN) via a flank approach. Patients and Methods: From August 1995 to November 1997, 29 men and 14 wome n (mean age 33 years) with severely damaged kidneys underwent RPN. Among th ese, 11 patients had undergone prior surgery, 3 had chronic renal failure, and 8 patients had a percutaneous nephrostomy. The RPN was performed via th ree or four ports, with the kidneys being removed intact from the retroperi toneal working space. During the same period, 43 patients underwent OSN thr ough a flank approach (extrapleural and extraperitoneal) for nonfunctioning or poorly functioning kidneys. Results: In the RPN group, two patients required conversion to OSN. The ope rative time and estimated blood loss ranged from 40 to 210 minutes (mean 11 4 minutes) and 50 to 450 mL (mean 127 mL), respectively. In the OSN group, the corresponding values were 60 to 100 minutes (mean 104 minutes) and 70 t o 600 mL (mean 266 mL), respectively. The mean length of hospitalization af ter RPN was considerably shorter-2 to 7 days (mean 3.4 days)-than after con ventional open surgery-4 to 16 days (mean 8.6 days). The incidences of mino r and major complications were 21% and 5%, respectively, in the RPN group a nd 33% and 2% in the OSN group. The postoperative analgesic requirement was significantly less (P < 0.001) in RPN group. The interval to return to nor mal activity ranged from 7 to 30 days (mean 20.3 days) and 20 to 60 days (m ean 32.9 days) in the RPN and OSN group, respectively, with superior perfor mance status, cosmesis, and quality of life observed in the former group. Conclusion: Retroperitoneoscopic nephrectomy is as effective as open nephre ctomy for benign kidney diseases with less postoperative pain, a shorter ho spital stay, earlier recuperation, and excellent cosmesis. This procedure c an also be performed in patients who have undergone abdominal operations pr eviously, in those with chronic renal failure, and in those with a percutan eous nephrostomy. The operation has become our first line of approach for b enign diseases of the kidney.