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Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 154-159

Laparoscopic radical nephrectomy: Our initial experience

Department of Urology, SGPGIMS, Lucknow, India

Correspondence Address:
Aneesh Shrivastava
Department of Urology, SGPGIMS, Raebareli Road, Lucknow - 226 014
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Source of Support: None, Conflict of Interest: None

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Objectives: The objective of the current study was to report our initial experience of transperitoneal laparoscopic radical nephrectomy with intact specimen extraction and to compare it with a similar cohort of pa­tients who underwent conventional open surgical proce­dure to assess the feasibility and advantage of laparoscopy in renal tumor surgery. Methods: Twenty patients (13 men and 7 women) with mean age of 55 years underwent transperitoneal laparo­scopic radical nephrectomy. The kidney was dissected laparoscopically together with the adrenal gland, perire­nal fat and Gerota's fascia. Intact specimen was removed through a small incision. Intra-operative and postopera­tive problems were analyzed and compared with the 16 comparable renal tumors operated by open procedures during the same period. Results: Of the 20 patients, 16 kidneys could be suc­cessfully removed laparoscopically. Four patients needed early conversion to open either due to technical problem in dissecting the hilar area because of larger tumor size or due to bleeding. Mean operating time was 3.5 hours and mean estimated blood loss was 290 ml. Two had intraoperative complications, one with splenic tear due to retraction injury and the other with bleeding from ad­renal vein avulsion. Laparoscopy costed about rupees 4.5 to 5 thousand more than open surgery while the incision length was 5 to 11 cm depending on the tumor size (mean 7 cm) as compared to 20-28 cm (mean 25 cm) in open surgery. Pathological tumor stage was T1NOMO in 16, T2NOMO in 1 patient treated laparoscopically, which were comparable to that of the conventional open group. Post­operative hospital stay was 3-7 days (mean 5 days) when compared to 5-12 days (mean 7 days) in the open group. Convalescence period was between 12 and 34 days (mean 19 days). No metastatic disease, local recurrence and seed­ing at the port site were observed during the follow-up period of 1-23 months (mean 12 months). Conclusions: Laparoscopic radical nephrectomy, al­though technically demanding and more expensive, is a viable option for managing localized renal tumors. It im­parts lesser morbidity, better cosmesis and early conva­lescence to the patient.

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