Laparoscopic versus open nephrectomy in 210 consecutive patients: outcomes, cost, and changes in practice patterns.
BACKGROUND
Initially slow to gain widespread acceptance within the urological community, laparoscopic nephrectomy is now becoming the standard of care in many centers. Our institution has seen a dramatic transformation in practice patterns and patient outcomes in the 2 years following the introduction of laparoscopic nephrectomy. We compare the experience with laparoscopic and open nephrectomy within a single medical center.


METHODS
Data were collected for all patients undergoing elective nephrectomy (live donor, radical, simple, partial, and nephroureterectomy) between August 1998 and September 2002. Data were analyzed by Wilcoxon rank sum, chi-square, and Fisher's exact test. A p-value <0.05 was considered significant.


RESULTS
Of the patients, 92 underwent open nephrectomy, and 118 were treated laparoscopically (87 hand-assisted laparoscopic nephrectomy, 31 totally laparoscopic). There was one conversion (0.8%). Patient demographics and indications for surgery were equivalent for both groups. Mean operative time for laparoscopic nephrectomy (230 min) was longer than for open (187 min, p = 0.0001). Blood loss (97 ml vs 216 ml, p = 0.0001), length of stay (3.9 days vs 5.9 days, p = 0.0001), perioperative morbidity (14% vs 31%, p = 0.01), and wound complications (6.8% vs 27.1%, p = 0.0001) were all significantly less for laparoscopic nephrectomy. For live donors, time to convalescence was less (12 days vs 33 days, p = 0.02), but hospital charges were more for patients treated laparoscopically (19,007 dollars vs 13,581 dollars, p = 0.0001).


CONCLUSIONS
Laparoscopic nephrectomy results in less blood loss, fewer hospital days, fewer complications, and more rapid recovery than open surgery. We believe that these benefits outweigh the higher hospital charges associated with the laparoscopic approach.
Kercher
K W
KW
Department of General Surgery, Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC 28203, USA, Kent.Kercher@carolinashealthcare.org
Heniford
B T
BT
Matthews
B D
BD
Smith
T I
TI
Lincourt
A E
AE
Hayes
D H
DH
Eskind
L B
LB
Irby
P B
PB
Teigland
C M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000601:surgery; D015331:Cohort Studies; D003289:Convalescence; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting / Q000191:economics / Q000379:methods; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery