title: Upper urinary tract retroperitoneoscopic surgery under epidural anesthesia: Shifting towards outpatient treatment.
abstract: OBJECTIVE
  Laparoscopy for urological surgery is usually carried out under general anesthesia. However, laparoscopy under epidural anesthesia has been reported to be successful for laparoscopic cholecystectomy, hernia repair, gynecological procedures, renal biopsy and renal cyst unroofing.
  
  
  METHODS
  From August 2011 to July 2013, 46 patients (26 male, 20 female) with a mean age of 35 years underwent retroperitoneoscopic surgery (15 nephrectomy, 21 ureterolithotomy, 10 renal cyst excision) under epidural anesthesia, performed by the same surgeon. Inclusion criteria were patients with benign upper urinary tract pathology, no history of flank operation, American Society of Anesthesiologists score I-II and body mass index less than 25. Pulse oximetry, electrocardiography, non-invasive arterial blood pressure and respiratory rate were monitored intraoperatively. The partial pressure of carbon dioxide in arterial blood and pain assessment via a visual analogue scale were assessed every 30 min. The serum cortisol level was measured to evaluate the surgical stress under epidural anesthesia.
  
  
  RESULTS
  All operations were completed laparoscopically with no conversion to open surgery. Hypotension was observed in six patients (13%) and 16 (34.7%) experienced shoulder pain. The mean operative time was 90 min. No postoperative analgesia was given. All patients could ambulate 4 h after the operation and were discharged on the same day; the mean hospital stay was 6.5 h.
  
  
  CONCLUSIONS
  Retroperitoneoscopy for benign upper tract pathology combined with epidural anesthesia is a feasible and an attractive method for both surgeon and patient. No postoperative pain and early recovery are the most beneficial results of this technique. Further studies, applying this technique in patients with cardiopulmonary problems, should be conducted.
authors.affiliation: Departments of Urology.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hammady
authors.forename: Wesam
authors.initials: W
authors.lastname: Abdelgalil
authors.forename: Elnesr
authors.initials: E
authors.lastname: Rashed
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Elbadry
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000639:trends*; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000453:epidemiology; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods; D014551:Urinary Tract / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*
keywords: Epidural anesthesia; outpatient surgery; retroperitoneoscopy