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Purpose: To determine whether day-case surgery (DS) laparoscopic pyeloplasty (LP) is feasible and safe., Patients and Methods: Thirty-two consecutive patients, planned for DS LP between March 2006 and January 2010 at a single urologic center, were enrolled in this retrospective observational study. Every patient underwent LP after a standard pathway of care for DS. We collected demographic and medical information, including renographic data. The success rate of DS and reasons for unplanned overnight admission and readmission were collected and evaluated., Results: There were 20 (62.5%) females and 12 (37.5%) males with a median age of 37 years (range 11 to 69 y). The pelviureteral junction obstruction was on the left side in 19 (59.3%) patients and on the right side in 13 (40.6%) patients. The most common symptom was loin pain (68.75%). The majority of patients were classified according to their physical status as American Society of Anesthesiologists (ASA) 1 (59.37%), ASA 2 (37.5%), and only one patient (3.1%) as ASA 3. Surgical time varied from 90 to 210 minutes (mean 148.9 min, standard deviation 34.70). Twenty-five (78.12%) patients were successfully discharged on the same day. Two (6.25%) patients were readmitted after surgery. On follow-up renography, 96.15% had improved drainage. This is a small retrospective study reporting initial experience., Conclusions: The DS LP is feasible and safe. To improve the success rate and to decrease the readmission rate, objective preoperative, intraoperative, and discharge criteria should be developed for DS and validated in randomized studies.

Purpose: To report our initial experience with day case surgery (DS) laparoscopic nephrectomy (LN) and to assess its feasibility and safety., Patients and Methods: Twenty-six consecutive patients, planned for DS LN between January 2006 and December 2009 at a single urologic center, were enrolled in this retrospective observational study. Every patient underwent LN after a standard pathway of care for DS. We collected data regarding demographic information, medical comorbidities, preoperative and postoperative symptoms, admission as well as discharge time and date. The success rate of DS and reasons for unplanned overnight admission and readmission were collected and evaluated., Results: There were 12 (46.15%) women and 14 (53.84%) men with a median age of 46 years (range 11-77 y). The LN was on the left side in 15 (57.7%) patients and on the right side in 11 (42.3%) patients. Fifteen (57.7%) patients had benign diseases associated with nonfunctioning kidney and 11 (42.3%) patients had renal masses. The most common symptom was loin pain-53.3% for the patients with nonfunctioning kidneys; the majority of patients with tumors (45.6%) were asymptomatic. Twenty-two (84.61%) patients were successfully discharged the same day. Six (23.07%) patients were readmitted after surgery., Conclusions: The DS LN is feasible and safe. We believe that the results should be easily reproducible. Increasing experience may help to develop more rigorous preoperative, intraoperative, and discharge criteria to increase the success rate and to decrease the readmission rate for DS LN.

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.

Introduction: Over the last decades there has been an ascending trend towards minimally invasive techniques for managing PUJO (pelvi-ureteric junction obstruction). The aim of the present retrospective study is to report the initial experience and to assess the feasibility and safety of day case laparoscopic pyeloplasty. Material and Methods: Data on all patients who underwent day case laparoscopic pyeloplasty from October 2006 to October 2008 was collected. The inclusive criterion for this study was patients with PUJO who were planned for day case laparoscopic pyeloplasty. All patients followed a standard pathway of care for day case laparoscopic procedure. The diagnosis of PUJO was confirmed by diuretic renography (furosemide technetium-99m mercaptoacetyltriglycine renal scan) in all cases. To assess the functional result of the pyeloplasty and to have an objective measurement the renal scan was repeated between three and six months postoperatively. The success rate of DS and readmission rate were collected and evaluated. Results: During the study period there were 15 patients with PUJO planned for day case transperitoneal laparoscopic pyeloplasty. Age ranges from 11 to 68 years old. American Society of Anaesthesiology (ASA) was three in one case and 1 and 2 for the other patients. The patient with an ASA of three failed to be discharged. Three patients had medical co-morbidities: cardiac or respiratory. Fourteen patients have been successfully discharged and one patient failed discharge. No patient needed reassessment after discharge. Conclusion: Although the numbers in our series are too small to draw final conclusions, we think that patients, physicians and also hospitals could benefit if in selected cases the laparoscopic pyeloplasty is done as day-case surgery, without compromising the safety of the patient. [ABSTRACT FROM AUTHOR]