Laparoscopic simple nephrectomy: Perioperative outcomes at srinagarind hospital

Abstract

Background: Laparoscopic urology is a minimally invasive alternative to open surgery, especially laparoscopic simple nephrectomy for benign disease such as KUB stone. Objective: To evaluate the efficacy and perioperative outcomes of laparoscopic simple nephrectomy at Srinagarind Hospital. Material and Method: Analyzed the demographic and perioperative data of 78 consecutive patients who underwent laparoscopic simple nephrectomy. Results: Mean age was 54.1. The indications included non-functioning kidney (64) and infection (14). Surgery averaged 118.37 minutes. In 38 and 40 respective cases, a transperitoneal and retroperitoneal approach was used. Intraoperative complications (13; 16.7%) included 10 bleeding, 2 diaphragmatic injuries and 1 pancreatic injury. Six cases (10.3%) were converted to open surgery: 5 for massive adhesion and 1 for uncontrolled bleeding. Mean estimated blood loss was 170.99 ml. Post-operative complications included: 8 cases of prolonged ileus and 5 wound infections. Mean post-operative analgesia was 14.0 mg morphine: mean pain score at post-operative day 1 6.20. Mean time to oral intake was 1.48 days, and postoperative period 4.63 days. Retroperitoneal access was associated with: shorter operative time (103.83 vs. 133.68 minutes, p = 0.008); a better result vis-a-vis post-operative ileus (1 vs. 7, p = 0.021); and shorter time to oral intake than transperitoneal route (1.20 vs. 1.79 days, p = 0.004). Conclusion: Vis-a-vis reducing pain, faster recovery and improved cosmetics laparoscopic nephrectomy by a skilled surgeon via retroperitoneal approach is preferred for benign diseases.