Laparoscopic nephrectomy: initial experience and cost implications


6 Mater Hospital, Crumlin Road, Belfast, UK.


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 £2000, comprising £100 for equipment, £900 theatre costs and £1000 for hospital stay. Using disposable equipment adds up to £900 to the cost. In comparison an open nephrectomy typically costs around £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.