What are advantages of laparoscopic radical nephrectomy over open nephrectomy?

Updated: Feb 05, 2019
  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Laparoscopy is gaining worldwide acceptance in the treatment of organ-confined renal cancer. Both laparoscopic radical nephrectomy and laparoscopic nephron-sparing procedures are viable alternatives to traditional open, radical, and partial nephrectomy surgeries. [15, 16, 17] Advantages of laparoscopic radical nephrectomy over open nephrectomy include the following:

  • Decreased need for postoperative analgesic drugs (average of 24 mg of parenteral morphine compared with 40 mg in open surgery).

  • Shorter hospital stay (median of 1.5 d compared with 5 d in open surgery).

  • Shorter convalescence period (median of 4 wk compared with 8 wk in open surgery).

Laparoscopy appears to offer the same cancer control results as open surgery, with comparable disease-free survival at 5 years and, recently, at 10 years.

Laparoscopic radical nephrectomy can be performed using the transperitoneal or the retroperitoneal approach. The retroperitoneal approach showed some benefit in quicker vascular control and less operative time. Both approaches are similar in terms of other patient outcomes.

Although laparoscopic radical nephrectomy for organ-confined kidney cancer is now considered the standard of care, several reports concerning locally invasive kidney cancer treated laparoscopically show promising results. Now, the challenge for each urologist is to learn these new technologies if he or she wants to be part of this rapidly growing field.

A study by Romao et al compared the outcomes of laparoscopic nephrectomy with open radical nephrectomy in the management of consecutive pediatric neoplasms. The study reported that laparoscopic nephrectomy is an attractive alternative to open surgery in carefully selected cases of pediatric renal tumors. The study also added that procedure length and incidence of intra-operative rupture were not increased, while post-operative recovery and hospital stay were shorter for laparoscopic nephrectomy. [18]


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