title: Day case laparoscopic nephrectomy with vaginal extraction: initial experience.
abstract: OBJECTIVE
  To assess the feasibility of laparoscopic nephrectomy with vaginal extraction in an ambulatory setting.
  
  
  METHODS
  Two patients underwent a laparoscopic (1 was robot assisted) nephrectomy with vaginal extraction for a nonfunctioning kidney in an ambulatory setting. Both interventions were performed by the same surgical team comprising a urologic surgeon and a gynecologic surgeon. The operative specimen was vaginally extracted via an incision in the posterior fornix at the end of the intervention. Patients had to respect very strict socioenvironmental and clinical criteria. Anesthesia was achieved using short-acting agents. Only first- and second-step analgesics were used (morphine-free protocol). The main judgment criteria were visual analog scale assessment for postoperative pain, the Clavien-Dindo classification for surgical complications, and the hospital readmission rate.
  
  
  RESULTS
  Two female patients (37 and 41 years old) have been successfully operated with this technique. No major perioperative or postoperative complications (Clavien-Dindo grade >2) were reported, and no patient readmission was required. Postoperative pain was well managed with visual analog scale scores ≤ 5. Both patients operated in the ambulatory setting had Chung scores of 10 before their discharge.
  
  
  CONCLUSIONS
  Laparoscopic or robotic nephrectomy with vaginal extraction can be performed in an ambulatory setting in carefully selected patients. The association of fast-track surgical techniques and vaginal extraction by eliminating the abdominal wound extraction source of postoperative pain allows performing this operation in this setting with a high level of satisfaction.
authors.affiliation: Department of Urology, Lyon Sud University Hospital, Pierre Benite, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Baldini
authors.affiliation: Department of Gynecology, Lyon Sud University Hospital, Pierre Benite, France; Department of Oncologic Surgery, Lyon Sud University Hospital, Pierre Benite, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Golfier
authors.affiliation: Department of Anesthesiology and Reanimation, Lyon Sud University Hospital, Pierre Benite, France.
authors.forename: Khaled
authors.initials: K
authors.lastname: Mouloud
authors.affiliation: Department of Anesthesiology and Reanimation, Lyon Sud University Hospital, Pierre Benite, France.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Bruge Ansel
authors.affiliation: Department of Urology, Lyon Sud University Hospital, Pierre Benite, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Navarro
authors.affiliation: Department of Urology, Lyon Sud University Hospital, Pierre Benite, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
authors.affiliation: Department of Urology, Lyon Sud University Hospital, Pierre Benite, France; Université Claude Bernard Lyon 1, Lyon, France. Electronic address: philippe.paparel@chu-lyon.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Paparel
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D061214:Patient Safety; D012371:Robotics / Q000379:methods*; D012494:Sampling Studies; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*