The metabolic response to laparoscopic and open nephrectomy

The metabolic response to nephrectomy was studied in patients undergoing laparoscopic (n = 10) and open (n = 10) nephrectomy using a standardized anaesthetic technique. The median percentage change from baseline in urinary free cortisol excretion was significantly greater and prolonged in the open group. The median percentage change from baseline in urinary adrenaline excretion was greater in the laparoscopic group at 24 h, but fell rapidly thereafter and was significantly lower than in the open group by 48 h following surgery. Although there was no significant difference between the two groups at 24 h, post-operative pulmonary function and oxygen-ation were significantly better in the laparoscopic group at 48 h following operation. Laparoscopic nephrectomy evokes a lesser stress response than its open counterpart and results in superior post-operative pulmonary function. It offers real biological advantages over conventional surgery to patients with limited cardiorespiratory and nutritional reserves (and perhaps malignancy), and potential benefits to all patients requiring nephrectomy.