title: Concomitant laparoscopic urological procedures: Does it contribute to morbidity?
abstract: OBJECTIVE
  With advancement in minimal access surgery two laparoscopic procedures can be combined together shortening the total hospital stay, decreasing morbidity and overall reduced cost. Combining two laparoscopic procedures in a single session has been reported in general surgery. Very few articles are available in literature with regard to combined urological laparoscopic surgeries. This article retrospectively analyses the outcomes of multiple laparoscopic procedures performed in a single stage at our centre.
  
  
  METHODS
  Patients undergoing simultaneous procedures from May 2003 to Jan 2009 were included in the study. Patients were categorised into three groups according to the primary urological organ involved, for better comparison with the control group. Diseases involving the adrenals gland were grouped in (group 1), kidney (group 2) and renal collecting system/ureter (group 3). All patients had one urological procedure for either of the above-mentioned organs combined with another surgical procedure. Similarly three control groups were chosen according to the primary urological organ involved (group 1c- unilateral laparoscopic adrenalectomy, group 2c- unilateral laparoscopic radical nephrectomy and group 3c- unilateral laparoscopic ureterolithotomy) for comparative study. The operative details, hospital stay and complications were analysed.
  
  
  RESULTS
  Thirty-two patients underwent 64 laparoscopic procedures under single anaesthesia. The most common procedure in this series was laparoscopic adrenalectomy (n=34) followed by laparoscopic nephrectomy (n=13). Group 1 patients had a prolonged operative time ( P=0.012) and hospital stay ( P=0.025) when compared with group 1c. However, blood loss was comparable in both the groups. Patients in groups 2 and 3 had comparable operative times, blood loss and recovery period with respect to their controls. Intraoperatively, the end tidal carbon dioxide levels were within permissible limits. All procedures were completed using the laparoscopic approach, without any conversion.
  
  
  CONCLUSIONS
  Simultaneous laparoscopic procedures can be done for urological diseases in selected patients with the advantages of single anaesthesia and hospital admission without increasing the morbidity.
authors.affiliation: Department of Urology, Amrita Institute of Medical Sciences, Kochi - 682 041, India.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Maurya
authors.forename: S E
authors.initials: SE
authors.lastname: Sivanandam
authors.forename: Sudhir
authors.initials: S
authors.lastname: Sukumar
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhat
authors.forename: Ginil
authors.initials: G
authors.lastname: Kumar
authors.forename: Balagopal
authors.initials: B
authors.lastname: Nair