Day case laparoscopic nephrectomy: initial experience

Rationale: Laparoscopic nephrectomy tends to become the new gold standard surgical technique in a selected population (non–functioning kidney, localised renal cell carcinoma). Day surgery is a popular pathway of care and, procedures of ever–increasing complexity are being considered. Objective: The aim of the study was to report the postoperative complications of day case laparoscopic nephrectomy, according to the Clavien system, and, to assess the feasibility of the procedure performed as a day case. Material and Results: This study included all the patients considered for day case transperitoneal laparoscopic nephrectomy between May 2008 and November 2009. Sixteen consecutive patients were enrolled in this retrospective study. There were ten procedures on the left hand–side and six on the right hand–side. Age ranges from 22 to 77 years old. Male to female ratio was 9:7. The preoperative diagnosis was non–functioning kidney in 9 cases and kidney tumour in the other 7 cases. All but two patients have been discharged in the same day (87.5%). The readmission rate was of 12.5%. One wheel–chair bonded patient was readmitted four days after the procedure, because of adynamic ileus, and another one three days later because of wound infection. There were two grade I and one grade IV complications (Clavien system). The patient readmitted with grade IV complication, wheel–chair bonded because of cerebral palsy, was not a typical day surgery patient. Discussion: The vast majority of complications were minor and resulted in no residual disability. In our small series, the day case laparoscopic nephrectomy was feasible and safe. Abbreviations: day surgery (DS), laparoscopic nephrectomy (LN), American Society of Anesthesiology (ASA)