Skip to main content
SpringerLink
Log in

Laparoskopische vs. offene Nephrektomie

10-Jahres-Ergebnisse einer nichtrandomisierten Vergleichsstudie an 549 Patienten mit benignen Nierenerkrankungen

  • Leitthema
  • Published:
Der Urologe, Ausgabe A Aims and scope Submit manuscript

Zusammenfassung

Es werden die Ergebnisse einer nichtrandomisierten Vergleichsstudie zwischen offener und laparoskopischer Nephrektomie bei Patienten mit benignen Nierenerkrankungen vorgestellt.

In den Jahren 1993–2002 wurden an der Klinik und Poliklinik für Urologie der Medizinischen Universität zu Lübeck und an der Universitätsklinik und Poliklinik für Urologie der Martin-Luther-Universität Halle/Wittenberg insgesamt 549 Nephrektomien bei Patienten mit benignen Nierenerkrankungen vorgenommen. In der offenen Nephrektomiegruppe waren 236 Patienten und in der Laparoskopiegruppe 313 Patienten. Klinische Parameter wurden für beide Gruppen erhoben und miteinander verglichen.

Die mediane Operationszeit betrug in der offenen Nephrektomiegruppe 90 (30–240) min sowie in der Laparoskopiegruppe 90 (41–210) min. In dieser Gruppe lag die Komplikationsrate mit 54 bei 17,2% und in der offenen Nephrektomiegruppe mit 60 bei 25,4%. In der Laparoskopiegruppe wurden eindeutige Vorteile hinsichtlich der Parameter Analgetikabedarf, Krankenhausverweildauer und Rekonvaleszenz nachgewiesen.

Die laparoskopische Nephrektomie resultiert in einem deutlich abgekürzten und günstigeren postoperativen Verlauf im Vergleich zur offenen Nephrektomie. Auch wegen der relativ geringen Fallzahlen bleibt die laparoskopische Nephrektomie jedoch ein überwiegend zentrumsgebundener Eingriff. Dort sollte dieses Verfahren zur Nephrektomie bei benignen Nierenerkrankungen primär zum Einsatz kommen.

Abstract

We report the results from a nonrandomized comparison of open flank vs laparoscopic nephrectomy in patients with benign renal disease.

Between 1993 and 2002, 549 nephrectomies for benign renal disease were performed at the Department of Urology of the Medical University of Lübeck and the Urological Department of the Martin Luther University in Halle/Wittenberg. There were 236 patients in the open flank nephrectomy group and 313 patients in the laparoscopic nephrectomy group. Clinical parameters were compared among both groups.

Median operative time in the open flank nephrectomy group was 90 min (range: 30–240 min) and also 90 min in the laparoscopic nephrectomy group (range: 41–210 min). There were 54 complications (17.2%) in the laparoscopic nephrectomy group compared to 60 complications (25.4%) in the open flank nephrectomy group. Patients in the laparoscopy group demonstrated clear advantages in terms of analgesic use for pain control, hospital stay, and convalescence.

Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. However, due to a limited number of patients, a laparoscopic nephrectomy is mainly reserved for laparoscopic centers. Nevertheless, the laparoscopic approach should be offered to the majority of patients with benign renal disease requiring nephrectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1.
Abb. 2.
Abb. 3.

Literatur

  1. Beisland C, Medby PC, Sander S, Beisland HO (2000) Nephrectomy indications, complications and postoperative mortality in 646 consecutive patients. Eur Urol 37: 58–64

    Google Scholar 

  2. Clayman RV, Kavoussi LR, Soper NJ et al. (1991) Laparoscopic nephrectomy: initial case report. J Urol 146: 278–282

    Google Scholar 

  3. Darby CR, Cranston D, Raine AEG, Morris PJ (1991) Bilateral nephrectomy before transplantation: indications, surgical approach, morbidity and mortality. Br J Surg 78: 305–307

    Google Scholar 

  4. Doehn C, Fornara P, Fricke L, Jocham D (1998) Comparison of laparoscopic and open nephroureterectomy for benign disease. J Urol 159: 732–734

    Google Scholar 

  5. Doublet JD, Barreto HS, Degremont AC, Gattegno B, Thibault P (1996) Retroperitoneal nephrectomy: Comparison of laparoscopy with open surgery. World J Surg 20: 713–716

    Google Scholar 

  6. Ehrlich R, Gershman A, Fuchs G (1994) Laparoscopic renal surgery in children. J Urol 151: 735–739

    Google Scholar 

  7. Eraky I, El-Kappany HA, Ghonheim MA (1995) Laparoscopic nephrectomy: Mansoura experience with 106 cases. Br J Urol 75: 271–275

    Google Scholar 

  8. Flechner SM, Gow JG (1980) Role of nephrectomy in the treatment of non-functioning or very poorly functioning unilateral tuberculous kidney. J Urol 123: 822–825

    Google Scholar 

  9. Fornara P, Doehn C, Fricke L, Hoyer J, Jocham D (1997) Laparoscopy in renal transplant patients. Urology 49: 521–527

    Google Scholar 

  10. Fornara P, Doehn C, Seyfarth M, Jocham D (2000) Why is laparoscopy minimally invasive? Eur Urol 37: 241–250

    Google Scholar 

  11. Gaur DD, Agarwal DK, Purohit KC (1993) Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol 149: 103–105

    Google Scholar 

  12. Gill IS, Kavoussi LR, Clayman RV et al. (1995) Complications of laparoscopic nephrectomy in 185 patients: a multi-institutional review. J Urol 154: 479–483

    Google Scholar 

  13. Keeley FX, Tolley DA (1998) A review of our first 100 cases of laparoscopic nephrectomy: defining risk factors for complications. Br J Urol 82: 615–618

    Google Scholar 

  14. Kerbl K, Clayman RV, McDougall EM et al. (1994) Transperitoneal nephrectomy for benign disease of the kidney: a comparison of laparoscopic and open surgical techniques. Urology 43: 607–613

    Google Scholar 

  15. McDougall EM, Clayman RV (1994) Laparoscopic nephrectomy and nephroureterectomy in the octogenarian with a renal tumour. J Laparoendosc Surg 4: 233–236

    Google Scholar 

  16. Miller K (1996) Laparoscopic operations in urologic clinics results of a survey. Urologe A 35: 223–225

    Google Scholar 

  17. Ottelin MC, Bueschen AJ, Lloyd LK, Joseph DB, Diethelm AG, Burns JR (1994) Review of 333 living donor nephrectomies. South Med J 87: 61–64

  18. Parra RO, Perez MG, Boullier JA, Cummings JM (1995) Comparison between standard flank versus laparoscopic nephrectomy for benign renal disease. J Urol 153: 1171–1174

    Google Scholar 

  19. Rassweiler J, Fornara P, Weber M et al. (1998) Laparoscopic nephrectomy: the experience of the laparoscopy working group of the german urological association. J Urol 160: 18–21

    Google Scholar 

  20. Sachs L (1997) Rangvarianzanalyse für mehrere verbundene Stichproben. In: Sachs L (ed) Angewandte Statistik. Anwendung statistischer Methoden. Springer, Berlin Heidelberg New York Tokio, pp 664–675

  21. Schiff Jr M, Glazier WB (1977) Nephrectomy: indications and complications in 347 patients. J Urol 118: 930–931

  22. Scott Jr RV, Selzman HM (1966) Complications of nephrectomy: review of 450 patients and a description of a modification of the transperitoneal approach. J Urol 95: 307–312

  23. Slakey DP, Wood JC, Hender D, Thomas R, Cheng S (1999) Laparoscopic live donor nephrectomy: advantages of the hand-assisted method. Transplantation 68: 581–583

    Google Scholar 

  24. Fornara P (2002) Portmetastasen: Fakt oder Fiktion? Urologe A 41: 113–119

  25. Vögeli TA, Burchardt M, Sulser T, Fornara P, Rassweiler J (2002) Ergebnisse der bundesweiten Datenerhebung über die urologische Laparoskopie: Urologe A 41:120–122

    Google Scholar 

  26. Doehn C, Fornara P, Jocham D (2002) Urologische Laparoskopie bei marginalen Patienten. Urologe A 41: 123–130

    Google Scholar 

  27. Viner NA, Rawl JC, Braren V, Rhamy RK (1975) Bilateral nephrectomy: an analysis of 100 consecutive cases. J Urol 113: 291–294

    Google Scholar 

  28. Winfield HN, Donovan JF, Godet AS, Clayman RV (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 7: 521–526

    Google Scholar 

  29. Wolf JS Jr, Moon TD, Nakada SY (1998) Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy. J Urol 160: 22–27

    Google Scholar 

  30. Yarimizu SN, Susan LP, Straffon RA, Stewart BH, Magnusson MO, Nakamoto SS (1978) Mortality and morbidity in pretransplant bilateral nephrectomy; analysis of 305 cases. Urology 12: 55–58

    Google Scholar 

  31. Fornara P, Doehn C, Friedrich H-J, Jocham D (2001) Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease. Eur Urol 40: 24–31

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Urologie, Martin-Luther-Universität, Halle/Wittenberg

    P. Fornara, M. Zacharias & M. Steinacker

  2. Klinik und Poliklinik für Urologie, Medizinische Universität, Lübeck

    C. Doehn & D. Jocham

  3. Universitätsklinik und Poliklinik für Urologie, Martin-Luther-Universität Halle/Wittenberg, Magdeburger Straße 16, 06112, Halle

    P. Fornara

Authors
  1. P. Fornara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Zacharias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Steinacker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Doehn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Jocham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Fornara.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fornara, P., Zacharias, M., Steinacker, M. et al. Laparoskopische vs. offene Nephrektomie. Urologe [A] 42, 197–204 (2003). https://doi.org/10.1007/s00120-002-0273-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-002-0273-4

Schlüsselwörter

Keywords

Search

Navigation