Possible impact of continuous drainage after minimally invasive partial nephrectomy

Abstract

Purpose: Postoperative management of minimally invasive partial nephrectomy (MIPN) without drain placement is common, but the effects on patients are unclear. We investigated the impact of no drain placement after MIPN.

Methods: We retrospectively studied 194 consecutive patients who underwent laparoscopic and robotic partial nephrectomy at one academic center. The study group included 46 evaluable patients without drain placement. The quantity of postoperative fluid collection in the perirenal space was calculated using computed tomography. The preoperative and postoperative serum concentrations of total protein, albumin, neutrophils, lymphocytes, monocytes numbers, and C-reactive protein (CRP) levels in the blood were compared between groups.

Results: Drains were placed in 148 (76.3 %) patients who underwent MIPN. The remaining 46 (23.7 %) patients did not have drain placement. Although the average total quantity of fluid discharged from the drain was 214 mL, the average fluid remaining in the perirenal space did not significantly differ with or without drain placement (20.3 vs. 16.8 mL, p = 0.64). The decrease in serum total protein and albumin was significantly greater with drain placement than without (total protein: 18.9 vs. 12.2 %, p < 0.001; and albumin: 24.7 vs. 22 %, p = 0.038). No drain placement also caused markedly greater decreases in lymphocytes and monocytes than did drain placement, whereas neutrophils and CRP did not differ based on drain placement.

Conclusion: Analysis of the quantity of fluid collection showed little need for routine drain placement. Not placing a drain after MIPN prevented serum protein loss and possibly accelerated wound-healing immune responses.

Keywords: Continuous drainage; Drain placement; Minimally invasive surgery; Partial nephrectomy; Renal neoplasms.