Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease

Objectives: We report the results from a nonrandomized comparison of open f lank versus laparoscopic nephrectomy in patients with benign renal disease. Methods: From January 1993 to December 1997, 249 nephrectomies for benign r enal disease were performed at our institution. There were 118 patients in the open flank nephrectomy group (median age 58.5, range 8-89 years) and 13 1 patients in the laparoscopic nephrectomy group (median age 40, range 16-7 3 years). Clinical parameters such as operative times, blood loss, transfus ion rates, conversion and complication rates, start of oral intake, analges ic consumption, duration of hospitalization and convalescence and short-ter m mortality were compared among both groups. Results: Median operative time in the open flank nephrectomy group was 90 ( range 30-240) min and also 90 (range 41-210) min in the laparoscopic nephre ctomy group. In the laparoscopy group 8 patients were converted to open sur gery (6.1 %). There were 27 complications (20.6%) in the laparoscopic nephr ectomy group compared to 30 complications (25.4%) in the open flank nephrec tomy group. Postoperatively, patients in the laparoscopic nephrectomy group required less morphine sulfate equivalent (12 vs. 20 mg) for pain control and they had a shorter hospital stay (4 vs. 10 days) and convalescence (24 vs. 36 days). The postoperative parameters are given, as medians and reache d statistically significant differences in favor of laparoscopic nephrectom y. Conclusions., Laparoscopic nephrectomy results in a significantly briefer p ostoperative course when compared to open flank nephrectomy. As a matter of fact laparoscopy in urology is still a center-related procedure and even i n these centers only a minority of urologists practice laparoscopy. However , in experienced centers the laparoscopic technique should be offered! to p atients with, benign renal disease who are scheduled for elective nephrecto my. Copyright (C) 2001 S.Karger AG,Basel.