A comparison of open, laparoscopic, and video-assisted minilaparotomy radical nephrectomy

Purpose: We have retrospectively compared the surgical outcomes of 2 forms of minimal invasive surgery for the surgical treatment of renal cell carcinoma, the laparoscopic and video-assisted minilaparotomy (VAM) surgery, with the conventional open technique in performing a radical nephrectomy. Materials and methods: Data from patients who underwent laparoscopic (n=14), VAM (n=15), and open (n=15) radical nephrectomies for renal cell carcinoma were reviewed. Laparoscopic radical nephrectomy was performed transperitoneally and VAM radical nephrectomy was performed using specially devised retractors such as piercing abdominal wall elevator and with endoscopic view using a telescope. Results: There were no significant differences among three groups undergoing laparoscopic, VAM, and open radical nephrectomies in terms of mean operative times (161 vs 160 vs 158 minutes, respectively). Time to oral intake, postoperative length of stay, amount of analgesics consumed for laparoscopic and VAM groups were not significantly different. However, these two groups significantly different from those of the open group. Complications included 1 transfusion and 1 paralytic ileus in the laparoscopic group, 1 transfusion in the VAM group, 2 transfusions and 2 paralytic ileus in the open group. Conclusions: Laparoscopic and VAM radical nephrectomy are associated with significantly less postoperative morbidity, time to oral intake, time to return to daily activity, postoperative length of hospital stay, and amount of analgesics consumed compared to conventional open radical nephrectomy. Therefore, in minimally invasive treatment of renal cell carcinoma, similar surgical outcomes can be expected whether purely laparoscopic or VAM technique for radical nephrectomy is adopted. Further prospective randomized studies are warranted.