Abstract
Introduction: Laparoscopic total nephrectomy (LTN) is nowadays the gold standard excision modality for both tumor and non-tumor renal pathology. With a more than 7-year presence in our department, laparoscopy is gaining more and more ground in our everyday urological practice. We aimed to analyze our experience with LTN, including learning curve analysis, in order to assess our gain in surgical experience with the new procedure.
Methods: We performed a retrospective cohort study in the Department of Urology, Mureș County Hospital and included all patients that benefited from laparoscopic total nephrectomy in the period 2017-2022. A total of 109 patients were included and their corresponding clinical and histopathological information was obtained from clinical records. Data was stratified according to patient demographics, histopathological diagnosis and operating surgeon.
Results: Age pyramid analysis revealed a predominance in male patients (62, 56,9%), whose age distribution was mostly in the intervals 60-65 (11, 10.09%) and 70-75(11, 10.09%). Most procedures were performed for tumor pathology (94, 86.2%), the most frequent histo-pathological diagnosis being clear cell carcinoma (71, 65.1%). Learning curve analysis was restricted to pT1 RCCs and performed for the two surgeons with the most experience for accuracy. A non-linear decrease in operative time was found for both surgeons, although not statistically significant.
Conclusion: Although limited in sample size, our study demonstrated a decreasing trend in operative time for laparoscopic total nephrectomy with the gain in experience, although inconsistent. Further studies with larger cohorts spanning on larger time intervals are necessary for a more thorough appreciation of surgical experience.