Korean J Urol.  2007 Mar;48(3):259-264. 10.4111/kju.2007.48.3.259.

Comparison of Laparoscopic Radical Nephrectomy with Open Radical Nephrectomy

• Kim TH
• Cho WY
• Kwak JJ
• Yoon JH
• Sung GT

• KMID: 1997122
• DOI: http://doi.org/10.4111/kju.2007.48.3.259

Abstract

PURPOSE
Laparoscopic surgery has become the standard surgical method within the urological community. This study was undertaken to evaluate the safety and efficacy of a standard laparoscopic radical nephrectomy (LRN) compared to an open radical nephrectomy (ORN) at a single medical center.
MATERIALS AND METHODS
Between January 2003 and March 2006, laparoscopic radical nephrectomies for renal cell cancer were performed in 30 patients and the results of the laparoscopic radical nephrectomy were compared with those of the open counterpart. Surgical results, such as the operation time, estimated blood loss (EBL), transfusion rate, narcotic analgesic requirement, hospital stay, complications and pathologic results, were retrospectively reviewed and analyzed using the Student's t-test.
RESULTS
There were no significant differences in the demographic data between the two groups. The pathological reports showed a clear cell type in 59 cases and a chromophobe type in 1 case. For the LRN and ORN groups, the mean operation times were 208 (120-320) vs. 206 min. (115-300) (p>0.05), EBL of 135 (100-200) vs. 318ml (100-2,000) (p=0.02), transfusion rates of 6.6 vs. 30%, narcotic analgesic requirements of 160 vs. 255mg diclofenac sodium, hospital stays of 6.7 vs. 10.5 days (p=0.04) and intraoperative complications in 0/30 (0%) vs. 2/30 cases (7%), respectively. The pathological surgical margins were all negative. The surgical and pathological parameters of the LRN group showed no significant differences to those of the ORN group, with the exception of the EBL and hospital stay.
CONCLUSIONS
Laparoscopic radical nephrectomy resulted in less blood loss, a shorter hospital stay and earlier rapid recovery than an open radical nephrectomy. In our opinion, laparoscopic surgery could be a standard surgical treatment in renal cell cancer.

Keyword

Renal cancer; Laparoscopy; Nephrectomy

MeSH Terms

Carcinoma, Renal Cell
Diclofenac
Humans
Intraoperative Complications
Kidney Neoplasms
Laparoscopy
Length of Stay
Nephrectomy*
Retrospective Studies
Diclofenac

Figure

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  Fig. 1 The renal artery and vein are exposed by retracting the lower pole of the kidney using a suction tip.

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  Fig. 2 The renal artery was ligated using 10mm Weck clips and Titanium clips, and the renal vein was transected using an Endo-GIA staqpler.

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  Fig. 3 En-block removal of the specimen containing the adrenal gland.

Reference

1. Robson CJ. Radical nephrectomy for renal cell carcinoma. J Urol. 1963. 89:37–42.

2. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991. 146:278–282.

3. Rassweiler J, Fornara P, Weber M, Janetschek G, Fahlenkamp D, Henkel T, et al. Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association. J Urol. 1998. 160:18–21.

4. Rodriguez A, Pow-Sang JM. Laparoscopic surgery in urologic oncology. Cancer Control. 2006. 13:169–178.

5. Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, et al. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol. 2000. 164:1153–1159.

6. Gill IS, Meraney AM, Schweizer DK, Savage SS, Hobart MG, Sung GT, et al. Laparoscopic radical nephrectomy in 100 patients: a single center experience from the Unitied States. Cancer. 2001. 92:1843–1855.

7. Flowers JL, Jacobs S, Cho E, Morton A, Rosenberger WF, Evans D, et al. Comparison of open and laparoscopic live donor nephrectomy. Ann Surg. 1997. 226:483–489.

8. Gill IS, Schweizer D, Hobart MG, Sung GT, Klein EA, Novick AC. Retroperitoneal laparoscopic radical nephrectomy: the Cleveland clinic experience. J Urol. 2000. 163:1665–1670.

9. Cadeddu JA, Ono Y, Clayman RV, Barrett PH, Janetschek G, Fentie DD, et al. Laparoscopic nephrectomy for renal cell cancer: evaluation of efficacy and safety: a multicenter experience. Urology. 1998. 52:773–777.

10. Portis AJ, Yan Y, Landman J, Chen C, Barrett PH, Fentie DD, et al. Long-term followup after laparoscopic radical nephrectomy. J Urol. 2002. 167:1257–1262.

11. Saika T, Ono Y, Hattori R, Gotoh M, Kamihira O, Yoshikawa Y, et al. Long-term outcome of laparoscopic radical nephrectomy for pathologic T1 renal cell carcinoma. Urology. 2003. 62:1018–1023.

12. Makhoul B, de la Taille A, Vordos D, Salomon L, Sebe P, Audet JF, et al. Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy. BJU Int. 2004. 93:67–70.

13. Portis AJ, Clayman RV. Sould laparoscopy be the standard approach used for radical nephrectomy? Curr Urol Rep. 2001. 2:165–170.

14. Hsu TH, Gill IS, Fazeli-Matin S, Soble JJ, Sung GT, Schweizer D, et al. Radical nephrectomy and nephroureterectomy in the octogenarian and nonagenarian: comparison of laparoscopic and open approaches. Urology. 1999. 53:1121–1125.

15. Wilee AH, Roigas J, Deger S, Tullmann M, Turk I, Loening SA. Laparoscopic radical nephrectomy: techniques, results and oncological outcome in 125 consecutive cases. Eur Urol. 2004. 45:483–488.

16. Gaur DD. Laparoscopic operative retroperitoneoscopy: use of new device. J Urol. 1992. 148:1137–1139.

17. Nambirajan T, Jeschke S, Al-Zahrani H, Vrabec G, Leeb K, Janetschek G. Prospective, randomized controlled study: transperitoneal lapsroscopic versus retroperitoneoscopic radical nephrectomy. Urology. 2004. 64:919–924.

18. Desai MM, Strzempkowski B, Matin SF, Steinberg AP, Ng C, Meraney AM, et al. Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy. J Urol. 2005. 173:38–41.

19. Ono Y, Kinukawa T, Hattori R, Yamada S, Nishiyama N, Mizutani K, et al. Laparoscopic radical nephrectomy for renal cell carcinoma: a five-year experience. Urology. 2001. 53:280–286.

20. Portis AJ, Elnady M, Clayman RV. Laparoscopic radical/total nephrectomy: a decade of progress. J Endourol. 2001. 15:345–354.

21. Janetschek G, Jeschke K, Peschel R, Strohmeyer D, Henning K, Bartsch G. Laparoscopic surgery for stage T1 renal cell carcinoma: radical nephrectomy and wedge resection. Eur Urol. 2000. 38:131–138.

22. Chan DY, Cadeddu JA, Jarrett TW, Marshall FF, Kavoussi LR. Laparoscopic radical nephrectomy: cancer control for renal cell carcimona. J Urol. 2001. 166:2095–2099.

23. Lee YS, Lee YH, Han WK, Soh BH, Yang SC, Rha KH. Laparoscopic transperitoneal radical nephrectomy for treating of renal cell carcinoma. Korean J Urol. 2006. 47:968–973.

24. Shuford MD, McDougall EM, Chang SS, LaFleur BJ, Smith JA Jr, Cookson MS. Complications of contemporary radical nephrectomy: comparison of open vs. laparoscopic approach. Urol Oncol. 2004. 22:121–126.

25. Guazzoni G, Montorsi F, Bocciardi A, Da Pozzo L, Rigatti P, Lanzi R, et al. Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumor: a comparative study. J Urol. 1995. 153:1597–1600.

26. Vargas HI, Kavoussi LR, Bartlett DL, Wagner JR, Venzon DJ, Franker DL, et al. Laparoscopic adrenalectomy: a new standard of care. Urology. 1997. 49:673–678.