LAPAROSCOPIC UROLOGIC SURGERY OUTCOME ASSESSMENT

Laparoscopic surgery is an evolving technique that began to be applied widely in urology in the early 1990s. We have conducted an ongoing mu lticenter study of laparoscopic urologic surgery to identify any chang es in utilization, complications, and short- and long-term outcomes. L aparoscopic urologic surgical procedures were assessed in three succes sive phases: retrospective initial experience [P1] (before 1991), and prospectively, an intermediate phase [P2] (1991-1992) and a late phase [P3] (1993-1994). The late phase group was followed for 1 year throug h 1995 to identify any delayed complications. In the P1 group, 114 pat ients are included; 105 underwent laparoscopic pelvic lymph node disse ction (LPLND), 7 underwent laparoscopic variocele ligation (LVL), and 2 underwent other procedures. The complication rates in P1 are 21% (to tal): 10.5% (major) and 10.5% (minor). The P2 group includes 148 patie nts; 132 underwent LPLND, 10 underwent LVL, and 6 underwent other proc edures. The complication rates decreased to 16.2% (total): 6% (major) and 10.1% (minor). The latest group (P3) includes 326 subjects; 245 ha d LPLND, 39 had LVL, and 42 had other procedures. More improvement in outcome is shown in this phase with a 7.98% total complication rate: 0 .92% major and 7.05% minor. In addition, other parameters such as oper ative time and hospital stay show improvement through the successive p hases. There were no significant long-term complications in the latest study group. This study demonstrates a continual improvement in outco me and changes in utilization patterns as urologists become more exper ienced with laparoscopic surgery. The complexity of the procedures per formed has increased with a decrease in the complication rates overall .