Single-centre experience of laparoscopic nephrectomy: Impact of learning curve on outcome.
OBJECTIVE
To present our experience of laparoscopic nephrectomies done for benign and malignant conditions; and the impact of learning curve on outcome.


METHODS
Retrospective study.


METHODS
Between January 2000 and September 2006, 396 laparoscopic nephrectomies were performed at our institute for various benign and malignant conditions. These included 250 simple nephrectomies, 48 nephroureterectomies, 95 radical nephrectomies, two partial nephrectomies and one hemi-nephrectomy. For the purpose of self-evaluation, we have divided our experience into two groups. Group 1 (learning phase) comprised the first 100 cases; Group 2 (consolidation phase) comprised cases performed after the initial learning phase. Retrospective evaluation of the case records was done to evaluate the differences in the operative and postoperative outcome.


METHODS
Student's 't' test using SPSS 14.0 software.


RESULTS
Demographic profile of the patients and relative indications of procedures performed were similar in the two groups. Mean operative time in Group 1 was 262 +/- 37 min, which reduced to 184 +/- 44 min in Group 2 (P<0.001). Mean operative blood loss was 310 +/- 58 ml and 198 +/- 88 ml (P<0.001); and blood transfusion was required in 38% and 13.5% of patients (P<0.001) of Group 1 and Group 2 respectively. There was a significant reduction in the intraoperative and postoperative complications from 16% in Group 1 to 3.4% in Group 2 (P<0.001). Similarly, conversion to an open procedure was required in 17% cases of Group 1 and 5.4% cases of Group 2 (P<0.01).


CONCLUSIONS
Laparoscopic nephrectomy is a viable option which can be performed safely with increasing experience.
Jha
Mrigank S
MS
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, UP, India.
Gupta
Nitin
N
Agrawal
Saurabh
S
Ansari
M S
MS
Dubey
Deepak
D
Mandhani
Anil
A
Srivastava
Aneesh
A
Kumar
Anant
A
Kapoor
Rakesh
R