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. 2024 Aug 29;16(8):e68142.
doi: 10.7759/cureus.68142. eCollection 2024 Aug.

Comparison of Intraoperative Results of Simple Open and Laparoscopic Nephrectomies in the Treatment of Benign Renal Pathologies in a First-Level Center in Mexico City

Alejandro Martinez-Esteban  1 , Natalia M Barron-Cervantes  1 , Kevin J Fuentes-Calvo  1 , Sara F Arechavala-Lopez  1 , Roxana Ramos-Carpinteyro  2 , J Jesus Cendejas-Gomez  2 , Carlos E Méndez-Probst  2
Affiliations

Comparison of Intraoperative Results of Simple Open and Laparoscopic Nephrectomies in the Treatment of Benign Renal Pathologies in a First-Level Center in Mexico City

Alejandro Martinez-Esteban et al. Cureus. .

Abstract

Objectives: To assess the efficacy and safety of simple open versus laparoscopic nephrectomies for treating benign renal pathologies, with a focus on comparing the prevalence of surgical complications at a first-level center in Mexico City.

Methods: A retrospective analysis spanning 2010-2020 was conducted where all patients undergoing simple nephrectomy for benign conditions were included and stratified into open and laparoscopic surgery groups. Variables analyzed included urological history, laboratory findings, surgical outcomes, complications, and histopathological results. Statistical comparisons employed Student's t-test for means and the chi-square test for frequencies. Additionally, binary logistic regression was utilized to identify predictors associated with conversion from laparoscopic to open surgery.

Results: The laparoscopic approach showed significant advantages in intraoperative bleeding (p=0.008) and intensive care unit stay (p=0.04). The conversion rate from laparoscopic to open surgery was 19.23%, with no significant risk factors identified for conversion.

Conclusions: Laparoscopic simple nephrectomy proves to be a secure and effective method in specialized urological centers with skilled surgeons, offering superior intraoperative outcomes compared to open surgery. It effectively reduces intraoperative hemorrhage, minimizes blood transfusion needs, and shortens hospital stays. Nonetheless, challenges such as equipment availability, costs, and surgeon expertise must be addressed. Further research focused on postoperative complications is crucial to advocate for broader adoption of laparoscopic nephrectomy as the preferred standard for treating relevant urological conditions, emphasizing substantial advantages over traditional open approaches.

Keywords: benign renal pathologies; hemorrhage; hospital stay; intraoperative results; laparoscopic nephrectomy; simple open nephrectomy.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Population distribution based on sex.
A graphical representation in the form of a pie chart depicting a total of 87 patients was studied: 21 men (24.1%) and 66 women (75.9%).
Figure 2
Figure 2. Distribution of the types of surgery.
A graphical representation in the form of a pie chart depicting the distribution of types of surgical procedures, where 40.22% of all the cases studied were approached by open surgery and 59.77% by laparoscopic surgery.
Figure 3
Figure 3. Forrest plot of intraoperative bleeding.
A graphical representation in the form of a box plot depicting a mean intraoperative bleeding of 97.45 mL (IQR: 77.12-118.25) was recorded in the group undergoing laparoscopic surgery (1), in contrast to a mean of 114.56 mL (IQR: 88.34-127.22) in the group undergoing open surgery (0). This difference was statistically significant (p=0.008, 95% CI).
Figure 4
Figure 4. Forrest plot of the length of stay in the intensive care unit.
A graphical representation in the form of a box plot depicting a reduction in the number of days of intensive care unit stay in the group that underwent laparoscopic surgery (1) compared to the group that underwent open surgery (0). In the laparoscopic group, the average length of stay was 7.12 days (IQR: 7.52-6.11), while in the open surgery group, it was 8.09 days (IQR: 8.27-7.99). This difference was statistically significant (p=0.04, 95% CI).
See this image and copyright information in PMC

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