Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours


Since Kavoussi et al. [1] reported the first laparopscopic radical nephrectomy in 1993, laparoscopy in urology has seen several advances. We evolved from open nephrectomy to laparoscopic radical nephrectomy (LRN), and then to robot-assisted laparoscopic partial nephrectomy, laparoendoscopic (LESS) nephrectomy and laparoscopic ablative technologies. Stroup et al., in this population-based study, have analysed the inpatient safety trends in laparoscopic and open radical nephrectomy in a nationwide database with validated patient safety measures. It is interesting to note that only ∼10% of radical nephrectomies in the USA are performed with laparoscopy almost 20 years after the first procedure was reported. It is also noteworthy that only in 2003 did patient safety indicators improve with LRN compared with the open approach. The authors have reported that patients undergoing laparoscopic surgery were more likely to be male, to have fewer comorbidities and to undergo surgery at an urban/teaching hospital. With the current pool of residents becoming trained in laparoscopy, this situation is most likely to change in the next 5–10 years as more urologists disseminate from urban centres and practise in community hospitals. One of the unfortunate factors that is associated with increasing prevalence of laparopsopy is the use of LRN for small renal masses [2]. Owing to technical challenges associated with laparoscopic partial nephrectomy, community urologists often offer a radical nephrectomy instead of an open partial nephrectomy. Since the use of partial nephrectomy in the USA is still relatively uncommon for small renal masses [3], urologists must be advised that preservation of renal function should be the paramount concern as opposed to practising a minimally invasive approach. Laparoscopy remains an evolving standard, even in the hands of experts, and urologists adopting the technique should be prudent in patient selection and practise meticulous technique in order to replicate the principles of open surgery.