Laparoscopic nephrectomy - impact of implementation

Abstract

Background: The urologic laparoscopy program started in Calderón Guardia Hospital (Costa Rica) in 2008 at the urology department, performing kidney laparoscopic surgeries. After overcoming a steep learning curve, surgical outcomes of minimaly invasive laparoscopic surgery were comparable to those established previously by open conventional surgery.Methods: All the patients who had a laparoscopic kidney procedure from 2008 to 2011 were included. The surgical records of the laparoscopic nephrectomy protocol were reviewed. Demographic characteristics, surgical information, surgical technique and approach as well as complications were analized. The histological diagnosis was reviewed in the follow up.Results: Since 2008, 200 laparoscopic kindey procedures had been performed, including 150 nephrectomies (radical and simple), 15 pyeloplasties, and 35 symptomatic benign cyst resections. On average, the neoplasic kidney specimens weighed 479.33 grams and measured 5.94 cms in diameter. More over. Of the 58 benign nephrectomies 45 corresponded to hydronephrosis, 3 pyonephrosis, 8 pyelonephritis and 2 polycystic kidney disease. Only 3% out of the 200 procedures were converted into open surgery, which is comparable to the best urologic centers.Conclusion: The benefits from implementing the kidney laparoscopy program in our institution are clearly established. Variables such as less postoperative pain, postoperative stay, patients reassuming their normal lives and returning to their jobs much faster compared to open surgery. Moreover, oncologic results are the same as in open surgery.