THE METABOLIC RESPONSE TO LAPAROSCOPIC AND OPEN NEPHRECTOMY

The metabolic response to nephrectomy was studied in patients undergoi ng laparoscopic (n = 10) and open (n = 10) nephrectomy using a standar dized anaesthetic technique. The median percentage change from baselin e in urinary free cortisol excretion was significantly greater and pro longed in the open group. The median percentage change from baseline i n urinary adrenaline excretion was greater in the laparoscopic group a t 24 h, but fell rapidly thereafter and was significantly lower than i n the open group by 48 h following surgery. Although there was no sign ificant difference between the two groups at 24 h, post-operative pulm onary function and oxygenation were significantly better in the laparo scopic group at 48 h following operation. Laparoscopic nephrectomy evo kes a lesser stress response than its open counterpart and results in superior post-operative pulmonary function. It offers real biological advantages over conventional surgery to patients with limited cardiore spiratory and nutritional reserves (and perhaps malignancy), and poten tial benefits to all patients requiring nephrectomy.