ABSTRACT
BACKGROUND AND PURPOSE: Clayman and associates first described laparoscopic nephrectomy in 1990. This paper describes the first randomized controlled trial to compare laparoscopic with open surgery for simple and radical nephrectomy. PATIENTS AND METHODS: Between 2001 and 2004, 45 patients requiring simple or radical nephrectomy (tumors as large as 8 cm) were randomized to either open surgery through a loin incision or laparoscopic nephrectomy (transperitoneal). Outcome measures included operative time, complications, hospital stay, pain scores, time to return to normal activities, and quality of life scores (EuroQol). RESULTS: The mean operative time was 105 minutes in the laparoscopic group and 93 minutes in the open-surgery group (P = 0.4). Blood loss, complications, and the mortality rate were similar in the two groups, as was the hospital stay at a median of 4 days in the laparoscopic group and 5 days in the open group (P = 0.9). Postoperative visual analog pain scores averaged 3.6 in the laparoscopic group compared with 5.4 in the open group (P = 0.02). There was no difference in pain scores at 3 months. Return to normal activities was faster in the laparoscopic group at 42 days v 62 days in the open group (P = 0.04). CONCLUSIONS: Laparoscopic nephrectomy is associated with less postoperative pain and a faster return to normal activities than open nephrectomy.
Subject(s)
Laparoscopy/methods , Nephrectomy/methods , Demography , Female , Humans , Kidney Neoplasms/surgery , Laparoscopy/adverse effects , Male , Middle Aged , Nephrectomy/adverse effects , Pain Measurement , Time Factors , Treatment OutcomeABSTRACT
In 1966 the government of India announced a new national population policy that eliminated numerical targets for new contraceptive acceptors. This paper examines the history of target setting in India and factors that led to the elimination of targets. The analysis is based on published and unpublished reports on India's population policy and the family planning programme and interviews with senior Indian and foreign officials and population specialists. Five factors are identified as playing a role in the evolution from target setting to a target-free policy:(1) the research of India's academics; (2) the work of women's health advocates; (3) the support of officials in the state bureaucracy who approved the target-free approach; (4) the influence of the donors to India's family planning programme, especially the World Bank; and (5) the International Conference on Population and Development.
