Laparoscopic nephrectomy: prediction of outcome in relation to the preoperative risk factors in two approaches

PURPOSE: The data on laparoscopic nephrectomy in Mansoura Urology & Nephrology Center were reviewed to identify the preoperative findings that may predict the need for conversion to open surgery. PATIENTS AND METHODS: One hundred sixty-three patients were subjected to transperitoneal laparoscopic nephrectomy, while 82 underwent retroperitoneal laparoscopic nephrectomy for benign renal diseases. The preoperative demographic data and laboratory and radiologic findings of these patients were correlated with failure rate of the laparoscopic procedure. RESULTS: The overall failure rate was 10.4% and 11% for the transperitoneal and retroperitoneal approach, respectively. Positive urine culture, renographic clearance of the removed kidney (>10 ml/min), and learning curve were independently associated with a greater risk of failure in patients undergoing transperitoneal nephrectomy. For the retroperitoneal approach, a positive urine culture, renographic clearance (> or =10 ml/min), and large kidney showed statistical significance. CONCLUSION: Preoperative data could be used as a predictor of laparoscopic nephrectomy outcome in patients with benign renal diseases. A more experienced surgeon should be selected for risky cases, bearing in mind the greater potential for early conversion to open surgery.