LAPAROSCOPIC NEPHRECTOMY - INITIAL EXPERIENCE AND COST IMPLICATIONS

Objective To assess the results and cost implications of laparoscopic nephrectomy. Patients and methods Ten patients underwent attempted laparoscopic nephrectomy and nephro-ureterectomy, The cost of the laparoscopic procedures was estimated to allow comparison with that of open surgery. Results Two patients required conversion to an open procedure, one for a colonic tear, the other for irretrievable loss of pneumoperitoneum. The median operating time for successful cases was 3 h (range 2.5-4), The mean morphine equivalent of analgesia delivered per patient was 18 mg (range 10-28), There was no mortality. Post-operative complications consisted of one case of prolonged ileus and another of chest infection, The median hospital stay of successful cases was 5 days (range 4-17), and the mean time to return to normal activity was 4 weeks (range 3-6), The cost of the procedure using re-usable instruments was approximately pound 2000, comprising pound 1OO for equipment, pound 900 theatre costs and pound 1000 for hospital stay. Using disposable equipment adds up to pound 900 to the cost, In comparison an open nephrectomy typically costs around pound 2300. Conclusion Laparoscopic nephrectomy is associated with lower analgesia requirements, shorter hospital stay and quicker return to work than equivalent open procedures. The cost, particularly when performed with re-usable instruments, is not prohibitive being comparable with that of open nephrectomy, With further experience it should become part of the armamentarium of urological surgeons.