Single-centre experience of laparoscopic nephrectomy: Impact of learning curve on outcome

Abstract

Aim:To present our experience of laparoscopic nephrectomies done for benign and malignant conditions; and the impact of learning curve on outcome.Settings and Design:Retrospective study.Materials and Methods:Between January 2000 and September 2006, 396 laparoscopic nephrectomies were performed at our institute for various benign and malignant conditions. These included 250 simple nephrectomies, 48 nephroureterectomies, 95 radical nephrectomies, two partial nephrectomies and one hemi-nephrectomy. For the purpose of self-evaluation, we have divided our experience into two groups. Group 1 (learning phase) comprised the first 100 cases; Group 2 (consolidation phase) comprised cases performed after the initial learning phase. Retrospective evaluation of the case records was done to evaluate the differences in the operative and postoperative outcome.Statistical Analysis Used:Student's ‘t’ test using SPSS 14.0 software.Results:Demographic profile of the patients and relative indications of procedures performed were similar in the two groups. Mean operative time in Group 1 was 262 ± 37 min, which reduced to 184 ± 44 min in Group 2 (P<0.001). Mean operative blood loss was 310 ± 58 ml and 198 ± 88 ml (P<0.001); and blood transfusion was required in 38% and 13.5% of patients (P<0.001) of Group 1 and Group 2 respectively. There was a significant reduction in the intraoperative and postoperative complications from 16% in Group 1 to 3.4% in Group 2 (P<0.001). Similarly, conversion to an open procedure was required in 17% cases of Group 1 and 5.4% cases of Group 2 (P<0.01).Conclusions:Laparoscopic nephrectomy is a viable option which can be performed safely with increasing experience.