Laparoscopic versus open partial nephrectomy.
OBJECTIVE
To compare, retrospectively, the results of laparoscopic partial nephrectomy (LPN) to open partial nephrectomy (OPN) using a tumor size-matched cohort of patients. Limited data are available comparing LPN to OPN in the treatment of small renal tumors.


METHODS
Between September 2000 and September 2003, 27 LPNs and 22 OPNs were performed to treat renal masses less than 4 cm. Patient demographics and tumor location and size (2.4 +/- 1.0 cm versus 2.9 +/- 0.9 cm, respectively; P = not statistically significant) were similar between the LPN and OPN groups.


RESULTS
Although the mean operative time was longer in the LPN than in the OPN group (210 +/- 76 minutes versus 144 +/- 24 minutes; P <0.001), the blood loss was comparable between the two groups (250 +/- 250 mL versus 334 +/- 343 mL; P = not statistically significant). No blood transfusions were performed in either group. The hospital stay was significantly reduced after LPN compared with after OPN (2.9 +/- 1.5 days versus 6.4 +/- 1.8 days; P <0.0002), and the postoperative parenteral narcotic requirements were lower in the LPN group (mean morphine equivalent 43 +/- 62 mg versus 187 +/- 71 mg; P <0.02). Three complications occurred in each group. With LPN, no patient had positive margins or tumor recurrence. Also, direct financial analysis demonstrated lower total hospital costs after LPN (4839 dollars+/- 1551 dollars versus 6297 dollars+/- 2972 dollars; P <0.05).


CONCLUSIONS
LPN confers several benefits over OPN concerning patient convalescence and costs, despite prolonged resection times at our current phase of the learning curve. Long-term results on cancer control in patients treated with LPN continue to be assessed.
Beasley
Kenneth A
KA
Division of Urology, University of Western Ontario, London, Ontario, Canada.
Al Omar
Mohamed
M
Shaikh
Alison
A
Bochinski
Derek
D
Khakhar
Anand
A
Izawa
Jonathan I
JI
Welch
Randy O
RO
Chin
Joseph L
JL
Kapoor
Anil
A
Luke
Patrick P W
PP
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D009864:Ontario; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional