Comparaison De La Néphrectomie Partielle Par Voie Laparoscopique Et Par Voie Ouverte : Une Expérience Multicentrique Française

Objectives : To compare open (OPN) and laparoscopic (LPN) partial nephrectomy (PN) techniques in the light of a French multicentre series.Material and methods : Data corresponding to 741 PN (91 laparoscopic and 650 open procedures) were compared in terms of the indications,tumour diameter operative data, complication rates and length of hospital stay.Results : Tumours were smaller in the LPN group (2.7 vs 3.4 cm, p=0.001). There were fewer malignant tumours (71.1% vs 80% p = 0.05) and jewer NP by necessity (20.9% vs 31.4%. p = 0.04) in the LPN group than in the OPN group. There were fewer hilar tumours in the LPN group than in the OPN group (LPN: 4% vs OPN: 14.8%, p = 0.03). Pedicle clamping was performed less frequently in the LPN group (33% vs 50.2%, p = 0.002) but for a significantly longer mean duration (35 minutes vs 19 minutes, p=0.0001). The mean operating time was longer in the LPN group (163 vs 150 minutes, p=0.02). The surgical complication rate (17.6% vs 14.3%), transfusion rate (6.6% vs 10.5%) and mean blood loss (363 vs 434 ml) were not significantly different between the 2 groups. There were significantly more urinary fistula (12.1% vs 2.5%, p < 0.001) and medical complications (24.2% vs 14%, p=0.01) in the laparoscopy group, but, in the longer term, urinary fistula rates were comparable in the 2 groups. The length of hospital stay was shorter for LPN (9.1 vs 11.2 days, p=0.009).Conclusion : This comparative series, reflecting initial experience, shows that laparoscopic partial nephrectomy achieves similar operative and perioperative results to those of open partial nephrectomy. However the indications for laparoscopic partial nephrectomy remain selective, as the pedicle clamping time and medical complication rates are higher with laparoscopic surgery. Experience and technical progress in laparoscopic partial nephrectonzy should make the operative technique comparable to that of open surgery.