Comparative Analysis of the Short Term Results of Retroperitoneoscopic and Open Nephrectomies for Non-Oncological Kidney Diseases

Background. With increasing acceptance of laparoscopic, retroperitoneoscopic and robotic procedures in urology over the last three decades, there is an ongoing discussion about the comparative outcomes of these procedures. Purpose: To report outcomes of retroperitoneoscopic nephrectomy (RPN) versus standard technique of open nephrectomy (ON) for various non oncological kidney diseases. Material and Methods: Clinical data of 347 patients who underwent nephrectomy from January 2019 to December 2019 were analyzed retrospectively. All patients were divided into 2 groups corresponding the surgical procedure. First group included 180 patients who underwent retroperitoneoscopic (RP) nephrectomy and second group consisted from 167 patients who underwent open nephrectomy. In both groups, the parameters of clinical outcome such as total blood loss, incision length, duration of surgical procedure, doses of nonsteroidal anti-inflammatory drugs used after surgery for pain relief and postoperative hospital stay are analyzed. We also assessed postoperative complications and classified. Results: The median amount of estimated blood loss was significantly lower (p \u003c 0.001) in RP nephrectomy group 10 (10-400, IQR-40) mL in RPN group and 100 (25-400; IQR-100) mL in ON group). The median incision length was 60 mm (40-100 mm; IQR – 30) vs. 150 mm (100–230 mm: IQR – 30), and the median postoperative hospital stay was 2 days (1-12 days; IQR-1) vs. 5 days (2–14 days; IQR-2), and doses of analgesic medication requirement were 150 mg (0-375 mg; IQR-150) vs. 225 mg (0–1025 mg; IQR-225) for RPN and open nephrectomy respectively. The median operative time was 90 min (20-210 min; IQR - 45) for RPN and 80 min (60-180 min; IQR - 15) for ON, which didn’t significantly differ (p = 0.711). Complications. In ON group in 33 (19,76%) patients we observed postoperative complications. Among them 15 (8.98%) patients developed incision site infection, in 5 (2.99%) patients there was bleeding from retroperitoneal drainage, which required to increase in draining time. Postoperatively 5 (2.99%) patients had bowel dysfunction, in 1 (0.6%) patient developed hospital acquired pneumonia, in 2 (1.2%) patients - myocardial infarction and acute cerebrovascular accident, in 3 (1.8%) patients – sepsis, in 1 (0.6%) patient – intestinal fistula. 1 (0.6%) patient died due to sepsis syndrome and multiorganal failure. In RPN group in 16 (8.89%) we observed postoperative complications. Among them 7 (3.9%) patients developed incision site infection, in 2 (1.11%) patients there was bleeding from drainage, in 6 (3.33%) patients had bowel dysfunction. 1 (0.55%) patient developed mild brachial plexopathy, which treated by the administration of analgesia and muscle relaxers. Conclusions: Short-term results demonstrate that retroperitoneoscopic nephrectomy has the same success rates as open, - thoracolumbothomic approach, but morbidity and complication rate are significantly lover. These findings suggest that RPN has the potential to replace open surgery as the standard for treatment of majority of kidney cases.