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    A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database

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    URI
    https://rde.dspace-express.com/handle/11287/622355
    Author
    Jenkins, James
    Foy, Christopher
    Davenport, Kim
    Journal
    Journal of Clinical Urology
    Type
    Journal Article
    Publisher
    Sage
    DOI
    10.1177/20514158211050008
    Rights
    Copyright © 2021, © SAGE Publications
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    Abstract
    Objectives:While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database.Patients and methods:All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed.Results:Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss (p = 0.001), transfusion rate (p = 0.02) and operative length (p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy (p = 0.02), nephroureterectomy (p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach.Conclusion:Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon.Level of evidence:4
    Publisher URL
    https://journals.sagepub.com/doi/abs/10.1177/20514158211050008?journalCode=urob
    Note
    The article is available via Open Access. Click on the 'Additional link' above to access the full-text.
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    • 2021 RD&E publications
    • Urology (urinary tract)

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