Mini- Laparoscopic Simple Nephrectomy Critical Assessment through A Randomized Trial

Abstract

Background: The conversion from open to laparoscopic simple nephrectomy was considered as an initial and most dramatic step toward progression, the second step is trying to miniaturization of the endoscope and instruments, in this study we aimed to evaluate miniaturization of laparoscopic simple nephrectomy looking for reduction perioperative morbidity and enhance cosmoses without significant operative disability. Patient and Methods: We prospectively reviewed 120 patients (60 in each group) who underwent trans-peritoneal conventional laparoscopy (CL) or mini laparoscopy (ML) simple nephrectomy between April 2015 and May 2018. The CL was done using 3 to 4 ports ranged from 5 to12 mm in diamond manner distribution. ML was done using same ports number and distribution ranged from 3- 5 mm except umbilical one was 10 mm. All operations were performed by same surgeon Results: However, ML experienced a significant longer operative time, significant more blood loss and insignificant increased conversion rate. The Post-operative data in the interest of ML were as follows; significantly lower pain scores, lower hospital stay, earlier return to activities and significant increase of cosmoses score of patients, Lastly, port site hernia was 6.7% in CL group and none in ML group (p = 0.042) Conclusion: ML trans-peritoneal simple nephrectomy is associated with lower post-operative pain, hospital stay, early return to normal activity, better cosmoses and less port site hernia. However operative time, blood loss and conversion rate are potentially more than CL.