[Comparison of open and laparoscopic partial nephrectomy: a French multicentre experience].
OBJECTIVE
To compare open (OPN) and laparoscopic (LPN) partial nephrectomy (PN) techniques in the light of a French multicentre series.


METHODS
Data corresponding to 741 PN (91 laparoscopic and 650 open procedures) were compared in terms of the indications, tumour diameter, operative data, complication rates and length of hospital stay.


RESULTS
Tumours were smaller in the LPN group (2.7 vs 3.4 cm, p = 0.001). There were fewer malignant tumours (71.1% vs 80% p = 0.05) and fewer NP by necessity (20.9% vs 31.4%. p = 0.04) in the LPN group than in the OPN group. There were fewer hilar tumours in the LPN group than in the OPN group (LPN: 4% vs OPN: 14.8%, p = 0.03). Pedicle clamping was performed less frequently in the LPN group (33% vs 50.2%, p = 0.002) but for a significantly longer mean duration (35 minutes vs 19 minutes, p = 0.0001). The mean operating time was longer in the LPN group (163 vs 150 minutes, p = 0.02). The surgical complication rate (17.6% vs 14.3%), transfusion rate (6.6% vs 10.5%) and mean blood loss (363 vs 434 ml) were not significantly different between the 2 groups. There were significantly more urinary fistulas (12.1% vs 2.5%, p < 0.001) and medical complications (24.2% vs 14%, p = 0.01) in the laparoscopy group, but, in the longer-term, urinarvfistula rates were comparable in the 2 groups. The length of hospital stay was shorter for LPN (9.1 vs 11.2 days, p = 0.009).


CONCLUSIONS
This comparative series, reflecting initial experience, shows that laparoscopic partial nephrectomy achieves similar operative and perioperative results to those of open partial nephrectomy. However, the indications for laparoscopic partial nephrectomy remain selective, as the pedicle clamping time and medical complication rates are higher with laparoscopic surgery. Experience and technical progress in laparoscopic partial nephrectomy should make the operative technique comparable to that of open surgery.
Crepel
Maxime
M
Service d'Urologie, Hôpital Pontchaillou, CHU Rennes France. maximecrepel@hotmail.com
Bernhard
Jean-Christophe
JC
Bellec
Laurent
L
Albouy
Baptiste
B
Lopes
David
D
Lacroix
Bertrand
B
De la Taille
Alexandre
A
Salomon
Laurent
L
Pfister
Christian
C
Soulie
Michel
M
Tostain
Jacques
J
Ferriere
Jean-Marie
JM
Abbou
Claude-C
CC
Guille
François
F
Bensalah
Karim
K
Vincendeau
Sébastien
S
Manunta
Andrea
A
Colombel
Marc
M
Patard
Jean-Jacques
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies