A REVIEW OF OUR FIRST 100 CASES OF LAPAROSCOPIC NEPHRECTOMY - DEFINING RISK-FACTORS FOR COMPLICATIONS

Objective To present the complications from our first 100 cases of lap aroscopic nephrectomy, a technically demanding procedure requiring len gthy experience, and to define the risk factors. Patients and methods Indications for laparoscopic nephrectomy included patients requiring n ephrectomy for benign pathology and those requiring nephroureterectomy for upper tract transitional cell carcinoma confined to the upper met er and/or renal pelvis. All patients were operated on by one surgeon ( D.A.T.) via a transperitoneal route and data on diagnosis, outcome and complications collected prospectively. Results The overall complicati on rate was 18%, of which 3% were major and 15% minor complications. F ive cases were converted to open surgery electively. Complications and conversions were associated with a history of pyonephrosis, previous renal surgery, staghorn calculi, polycystic kidney disease, and xantho granulomatous pyelonephritis. While there was no discernible decline i n the decrease in complications with experience, operative duration de creased from a mean of 204 min for the first 20 cases to 108 min for t he last 20. Complications and conversions were more closely associated with diagnosis than with the surgeon's experience. Conclusion Laparos copic nephrectomy and nephroureterectomy can be undertaken for a varie ty of indications with reasonable complication and conversion rates. A lthough inflammatory conditions increase the difficulty of these proce dures, we feel that patients requiring nephrectomy for benign disease should be offered a trial of laparoscopic surgery.