A Single Institution Experience of 141 Cases of Laparoscopic Radical Nephrectomy with Cost-Reductive Measures

Abstract

Laparoscopic radical nephrectomy (LRN) has benefits in terms of cosmesis, less postoperative pain, hospital stay, and early recovery when compared with open radical nephrectomy. One of the major points of concern of this surgery, especially in developing countries, is the additional cost because of the disposable instruments. We present our experience of laparoscopic radical nephrectomy with cost-reductive techniques. From 1998 to 2008, 141 patients undergoing cost-reductive LRN using minimal disposable equipment for clinically localized renal tumors were included in the study. Clinical data, including operative and postoperative management and follow-up, were recorded and analyzed statistically. The transperitoneal and retroperitoneal laparoscopic techniques were performed in 46.8% and 53.2 %, respectively. Overall, the mean operative time was 139.5 min, mean estimated blood loss was 192.3 mL, mean analgesic requirement was 12.69 mg morphine equivalent, and mean hospital stay was 3.6 days. There were eight conversions to open surgery. There were 10 major and 12 minor complications with no deaths. Mean follow-up was 54.2 months with no local recurrence. There were 17 distal recurrences with no port site metastasis. The cost of LRN, using the cost-reductive techniques, was reduced by approximately US $1,900 per case. Cost-reductive LRN is feasible for the management of clinically localized renal tumors. It provides all the advantages of laparoscopy and can be performed with minimal additional cost, making it more acceptable to the patients, especially in developing countries.