PRELIMINARY EXPERIENCE WITH URO-LAPAROSCO PIC PROCEDURES AND BENEFIT ANALYSIS

Preliminary experience with uro-laparoscopy was retrospectively analyz ed to determine whether patients profited from the laparoscopic proced ure. Between August 1991 and July 1993 we performed 53 operations lapa roscopically. Four more began in this way but ended in open surgery. 2 9 varicocele procedures were carried out. A reduced postoperative morb idity, and hence a benefit, were obvious in 3/29 patients with bilater al varicocele, but probably not in the remaining 26/29 patients affect ed only on the left side. 13 pelvic lymphadenectomies in patients with prostatic carcinoma T1-3, elevated prostatic acid phosphatase, a PSA >30 ng/ml and/or a suspected N+ on CT, served to identify 10 pN0 and 3 pN1 patients. Four of the pN0 patients with a T3 tumor were given rad iotherapy. Six with a T2 tumor underwent radical prostatectomy, four w ith margin-negative specimens benefited from laparoscopic lymphadenect omy by securing a curative operation which according to established ru les would otherwise have been withheld. Two patients with margin-posit ive specimens suffered harm from laparoscopic lymphadenectomy, which h ad led to a needless operation. Another lymphadenectomy performed on o ne more patient suffering from deep venous thrombosis of the left leg associated with pelvic lymphadenopathy established the benign histolog y of the enlarged lymph nodes with minimal morbidity. 10 nephrectomies were carried out for benign, clinically relevant lesions of the kidne y, which are rare. They produced a clear-cut benefit for all patients as the postoperative morbidity was minimal. We conclude that the prese nt indications for uro-laparoscopic procedures are either disputable o r rare. If laparoscopy is to acquire more than merely marginal importa nce in urology, new, more frequent and unquestionably useful indicatio ns will have to be found.