The British Association of Urological Surgeons Section of Endourology audit of laparoscopic nephrectomy

The Section of Endourology of the BAUS present an audit of their experience with laparoscopic nephrectomy covering a 1-year period. In this detailed analysis of results from 25 centres in the UK they found that results were similar to those reported in other parts of the world. They also showed that there was no difference in results between larger and smaller centres performing fewer than five cases per year, but suggest that this is a result of careful case selection and the use of mentors. OBJECTIVE To report the first UK national audit of laparoscopic nephroureterectomy, radical and simple nephrectomy. METHODS All members of the British Association of Urological Surgeons (BAUS) undertaking laparoscopic nephrectomy were invited to submit prospectively collected data from their centres to a nationally established database, using a standard proforma. The period covered by the audit was 1 July 2001 to 30 June 2002. The indications for surgery, peri- and postoperative data, and some demographic details were collected. RESULTS Data were received from 25 centres; 13 had undertaken five or fewer cases per year; 263 procedures were reported, including 20 of hand-assisted nephrectomy. Most cases were for nonfunctioning kidneys, or renal cell carcinoma, with transitional cell cancer and stones forming a smaller proportion. The mean (range) operative duration was 173 (89–335) min. The median postoperative stay was 4 days, with a wide range reflecting clinical and other reasons for delayed discharge. Two deaths were reported, giving a mortality of 0.7%. The mean conversion rate was 5.7% and the mean complication rate 16.8%; these rates were no higher in centres undertaking fewer than five cases per year than in the centres with a greater volume. CONCLUSION Encouragingly, this first UK audit of laparoscopic nephrectomy shows similar results to those published worldwide. The lack of any difference in outcome between smaller and larger centres may be explained by case selection and the use of mentors, as recommended by the BAUS Section of Endourology.