Comparison of the outcomes of Laparoscopic and Open Nephrectomy in Rajavithi Hospital
Tanet Thaidumrong MD*, Somjith Duangkae RN**
Affiliation : * MIS Urology Rajavithi, Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ** Department of Anesthesiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Since the first report of its use by Clayman et al in 1991, laparoscopic nephrectomy (LN) has been employed
worldwide as a new alternative therapy for both benign and malignant diseases. The current study focuses on a comparison
of the peri-operative and postoperative outcomes of LN and open nephrectomy (ON) and describes surgical techniques used
in LN in Rajavithi Hospital.
Objective : To compare the peri-operative and postoperative outcomes of laparoscopic (LN) and open nephrectomy (ON) and
to report surgical techniques used in laparoscopic nephrectomy in Rajavithi Hospital.
Material and Method: This was a retrospective study of the data of 97 patients who underwent open and laparoscopic
nephrectomy by a single surgeon in Rajavithi Hospital between 1 May 2007 and 31 December 2016. Fifty-three patients who
underwent LN were compared with 44 patients who had ON in terms of demographic, clinical and pathological data. The data
collected were operative time, intra-operative blood loss, blood transfusion rate, post-operative analgesic drug use, time to
return to normal activity, length of hospital stay, post-operative complications and size of surgical wound.
Results : No statistical significance was observed between ON and LN with respect to age, sex, underlying disease, ASA grade,
tumor location, tumor stage or number of cancer cases in each group. There was a significant difference in estimated blood
loss between ON and LN (871.59+1,125.62 ml vs. 290.00+262.00 ml, respectively; p = 0.002). There was also a significant
difference in number of doses of post-operative analgesic drugs (2.64+2.31 doses vs. 0.91+0.98 doses, respectively;
p<0.001) and length of hospital stay (8.91+3.89 days vs. 6.58+1.87 days, respectively; p = 0.001). Size of surgical wound
was also significantly different (15.66+3.62 cm vs. 3.68+0.58 cm, respectively), and there were significant differences in
complication rates, with 31.0% in ON and 13.2% in LN (p = 0.039). There was no mortality in either group of patients.
Conclusion : LN is a feasible, safe and effective procedure. Surgical outcomes with LN offer the advantages of decreased
blood loss, fewer blood transfusions, reduced postoperative pain, shorter length of hospital stay, and early convalescence
with improved cosmetic appearance of surgical wound.
Keywords : Kidney, Kidney neoplasms, Nephrectomy, Laparoscopy
