Background: Since the first report of its use by Clayman et al in 1991, laparoscopic nephrectomy (LN) has been employed worldwide as a new alternative therapy for both benign and malignant diseases. The current study focuses on a comparison of the peri-operative and postoperative outcomes of LN and open nephrectomy (ON) and describes surgical techniques used in LN in Rajavithi Hospital.
Objective: To compare the peri-operative and postoperative outcomes of laparoscopic (LN) and open nephrectomy (ON) and to report surgical techniques used in laparoscopic nephrectomy in Rajavithi Hospital.
Material and Method: This was a retrospective study of the data of 97 patients who underwent open and laparoscopic nephrectomy by a single surgeon in Rajavithi Hospital between 1 May 2007 and 31 December 2016. Fifty-three patients who underwent LN were compared with 44 patients who had ON in terms of demographic, clinical and pathological data. The data collected were operative time, intra-operative blood loss, blood transfusion rate, post-operative analgesic drug use, time to return to normal activity, length of hospital stay, post-operative complications and size of surgical wound.
Results: No statistical significance was observed between ON and LN with respect to age, sex, underlying disease, ASA grade, tumor location, tumor stage or number of cancer cases in each group. There was a significant difference in estimated blood loss between ON and LN (871.59+1,125.62 ml vs. 290.00+262.00 ml, respectively; p = 0.002). There was also a significant difference in number of doses of post-operative analgesic drugs (2.64+2.31 doses vs. 0.91+0.98 doses, respectively; p<0.001) and length of hospital stay (8.91+3.89 days vs. 6.58+1.87 days, respectively; p = 0.001). Size of surgical wound was also significantly different (15.66+3.62 cm vs. 3.68+0.58 cm, respectively), and there were significant differences in complication rates, with 31.0% in ON and 13.2% in LN (p = 0.039). There was no mortality in either group of patients.
Conclusion: LN is a feasible, safe and effective procedure. Surgical outcomes with LN offer the advantages of decreased blood loss, fewer blood transfusions, reduced postoperative pain, shorter length of hospital stay, and early convalescence with improved cosmetic appearance of surgical wound.

Keywords: Kidney, Kidney neoplasms, Nephrectomy, Laparoscopy