Laparoscopic nephrectomy: new standard of care?
OBJECTIVE
The pace of implementation of a laparoscopic nephrectomy programme is affected by factors including surgical expertise, case load, learning curves and outcome audits. We report our experience in introducing a laparoscopic nephrectomy programme over a 3-year period.


METHODS
From January 2001 to December 2003, 187 nephrectomies were performed (105 by conventional surgery, 82 by laparoscopy). Hand-assisted laparoscopy was used predominantly. The indications for surgery, factors affecting the approach and outcome parameters were studied. A cost comparison was made between patients with similar-sized renal tumours undergoing laparoscopic versus open surgery.


RESULTS
Most operations were performed for malignancy in both the open (70%) and laparoscopic (67%) surgery groups. The laparoscopic approach was most commonly used in upper tract transitional cell cancers (TCCs; 70% of 30 patients) and benign pathologies (49% of 35 patients), followed by radical nephrectomies (34% of 99 patients) and donor nephrectomies (44% of 23 patients). There was a rapid rise in laparoscopic surgeries, from 30% in 2001 to 58% in 2002. The median hospital stay was 5.8 days in the laparoscopic group and 8.1 days in the open surgery group. The procedure cost for laparoscopic surgery was 4,943 dollars compared with 4,479 dollars for open surgery. However, due to a shorter hospital stay, the total hospital cost was slightly lower in the laparoscopic group (7,500 dollars versus 7,907 dollars).


CONCLUSIONS
The laparoscopic approach for various renal pathologies was quickly established with a rapid increase in the number of laparoscopic procedures.
Sim
Hong Gee
HG
Department of Urology, Singapore General Hospital, Singapore.
Yip
Sidney K H
SK
Ng
Chee Yong
CY
Teo
Yee Sze
YS
Tan
Yeh Hong
YH
Siow
Woei Yun
WY
Cheng
Wai Sam
WS
D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*