How “simple” is laparoscopic transperitoneal simple nephrectomy for a novice surgeon

Introduction
To assess the perioperative outcome of laparoscopic transperitoneal simple nephrectomy and to see how difficult it is for a novice laparoscopic surgeon.

Materials and methods
The laparoscopic transperitoneal simple nephrectomy database between July 2012 and February 2019 was analyzed. The data of the first 50 cases performed by each of the three surgeons (group 1, 2, and 3) were divided into two subgroups- A: cases 1-25, and B: cases 26-50. Data analyzed included operative time, blood loss, conversion to open, the number of cases taken to reach a steady perioperative outcome and complications.

Results
Baseline characteristics of patients including the aetiology of the non-functioning/poorly functioning kidney were similar between the three groups. Though the mean operative time differs between the three surgeons, it decreased significantly till 20-25 cases and then remained steady thereafter among all three surgeons. The presence of hilar or perinephric inflammation secondary to pyonephrosis or stone disease was the factor associated with longer operative time and the need for conversion to open. The grade 3 or higher post-operative complications were similar between the three groups.

Conclusion
Operative time was the significant perioperative factor that became steady after approximately 20 cases of laparoscopic transperitoneal simple nephrectomy but not the other factors like blood transfusion rate or grade III complications.