LAPAROSCOPIC NEPHRECTOMY - INITIAL EXPERIENCE AND COST IMPLICATIONS

Objective To assess the results and cost implications of laparoscopic nephrectomy. Patients and methods Ten patients underwent attempted lap aroscopic nephrectomy and nephro-ureterectomy, The cost of the laparos copic procedures was estimated to allow comparison with that of open s urgery. Results Two patients required conversion to an open procedure, one for a colonic tear, the other for irretrievable loss of pneumoper itoneum. The median operating time for successful cases was 3 h (range 2.5-4), The mean morphine equivalent of analgesia delivered per patie nt was 18 mg (range 10-28), There was no mortality. Post-operative com plications consisted of one case of prolonged ileus and another of che st infection, The median hospital stay of successful cases was 5 days (range 4-17), and the mean time to return to normal activity was 4 wee ks (range 3-6), The cost of the procedure using re-usable instruments was approximately pound 2000, comprising pound 1OO for equipment, poun d 900 theatre costs and pound 1000 for hospital stay. Using disposable equipment adds up to pound 900 to the cost, In comparison an open nep hrectomy typically costs around pound 2300. Conclusion Laparoscopic ne phrectomy is associated with lower analgesia requirements, shorter hos pital stay and quicker return to work than equivalent open procedures. The cost, particularly when performed with re-usable instruments, is not prohibitive being comparable with that of open nephrectomy, With f urther experience it should become part of the armamentarium of urolog ical surgeons.