Retroperitoneal Laparoscopic Nephrectomy for Inflammatory Renal Diseases

Hyun Kee Cho; Doo Sang Kim; Dong Soo Ryu; Tae Hee Oh; Youn Soo Jeon

doi:10.4111/kju.2008.49.2.107

Journal List > Korean J Urol > v.49(2) > 1005030

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cho, Kim, Ryu, Oh, and Jeon: Retroperitoneal Laparoscopic Nephrectomy for Inflammatory Renal Diseases

Original Article

Korean J Urol 2008;49(2):107-112.

Published online: 17 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.2.107

Retroperitoneal Laparoscopic Nephrectomy for Inflammatory Renal Diseases

Hyun Kee Cho, Doo Sang Kim, Dong Soo Ryu¹, Tae Hee Oh¹, Youn Soo Jeon

^¹Department of Urology, College of Medicine, Soonchunhyang University, Cheonan, Sungkyunkwan University College of Medicine, Masan, Korea

교신저자: 전윤수 순천향대학교 천안병원 비뇨기과 충남 천안시 봉명동 23-20 330-721, TEL: 041-570-2275, FAX: 041-574-6248, E-mail: ysurol@schch.co.kr

Revised 10 October 2007 Accepted 1 November 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Retroperitoneal laparoscopic nephrectomy for inflammatory renal conditions remains technically challenging, but can prevent intraperitoneal contamination by inflammatory or pathologic materials and decrease the risk of visceral injury or peritoneal morbidity. We evaluated retroperitoneal laparoscopic nephrectomy in terms of feasibility, safety, and efficacy in inflammatory renal disease.

Materials and Methods

Between March 2003 and June 2006, retroperitoneal laparoscopic nephrectomy was performed in 39 patients with benign renal disease. Of the 39 patients, 18 (group 1) had inflammatory renal diseases with perinephric stranding on CT, which was confirmed as an adhesion during surgery. The remaining 21 patients (group 2) had nonfunctioning kidneys without significant inflammation. Intraoperative and postoperative clinical parameters were analyzed and compared between the 2 groups.

Results

Retroperitoneal laparoscopic nephrectomy was successful in all 39 patients without conversion to open surgery. Group 1 included tuberculous pyelonephritic kidney (n=11), xanthogranulomatous pyelonephritis (n=3), pyonephrosis (n=2) and renal abscess (n=2). Group 2 included chronic pyelonephritis (n=12), ureteropelvic junction obstruction (UPJ) stricture (n=6), and cystic disease (n=3). The mean operating time and the mean estimated blood loss were significantly different between the 2 groups (p ＜0.001). The mean time to oral intake and ambulation, and the mean duration of hospitalization were not different between the 2 groups. There were 1 major and 2 minor complications in group 1 and 2 minor complications in group 2.

Conclusions

Retroperitoneal laparoscopic nephrectomy is a feasible and safe treatment modality in inflammatory renal diseases as well as other benign renal diseases.

Keywords: Laparoscopy, Nephrectomy, Inflammatory renal disease

REFERENCES

1. Jay TB, Louis RK. Laparoscopic surgery of the kidney. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 9th ed.Philadelphia: Saunders;2007. 1759-61.

2. Gaur DD, Agarwal DK, Purohit KC. Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol. 1993; 149:103–5.

3. Gupta NP, Agrawal AK, Sood S. Tubercular pyelonephritic nonfunctioning kidney-another relative contraindication for laparoscopic nephrectomy: a case report. Adv Surg Tech A. 1997; 7:131–4.

4. Rassweiler J, Fornara P, Weber M, Janetschek G, Fahlenkamp D, Henkel T, et al. Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association. J Urol. 1998; 160:18–21.

5. Bercowsky E, Shalhav AL, Portis A, Elbahnasy AM, Mc-Dougall EM, Clayman RV. Is the laparoscopic approach justified in patients with xanthogranulomatous pyelonephritis? Urology. 1999; 54:437–42.

6. Shekarriz B, Meng MV, Lu HF, Yamada H, Duh QY, Stoller ML. Laparoscopic nephrectomy for inflammatory renal conditions. J Urol. 2001; 166:2091–4.

7. Chibber PJ, Shah HN, Jain P. Laparoscopic nephroureterectomy for tuberculous nonfunctioning kidneys compared with laparoscopic nephroureterectomy for other diseases. J Laparoendosc Adv Surg Tech A. 2005; 15:308–11.

8. Vanderbrink BA, Ost MC, Rastinehad A, Anderson A, Badlani GH, Smith AD, et al. Laparoscopic versus open radical nephrectomy for xanthogranulomatous pyelonephritis: contemporary outcome analysis. J Endourol. 2007; 21:65–70.

9. Hemal AK, Gupta NP, Kumar R. Comparison of retroperitoneoscopic nephrectomy with open surgery for tuberculous nonfunctioning kidneys. J Urol. 2000; 164:32–5.

10. Kim HH, Lee KS, Park KJ, Ahn HJ. Laparoscopic nephrectomy for nonfunctioning tuberculous kidney. J Endourol. 2000; 14:433–7.

11. Hemal AK, Gupta NP, Wadhwa SN, Goel A, Kumar R. Retroperitoneoscopic nephrectomy and nephroureterectomy for benign nonfunctioning kidneys: a single-center experience. Urology. 2001; 57:644–9.

12. Khaira HS, Shah RB, Wolf JS Jr. Laparoscopic and open surgical nephrectomy for xanthogranulomatous pyelonephritis. J Endourol. 2005; 19:813–7.

13. Zhang X, Zheng T, Ma X, Li HZ, Li LC, Wang SG, et al. Comparison of retroperitoneoscopic nephrectomy versus open approaches to nonfunctioning tuberculous kidney: a report of 44 cases. J Urol. 2005. 173:1586–9.

14. Kim HH, Lee KS, Park K, Ahn H. Laparoscopic nephrectomy for tuberculous kidney. Korean J Urol. 2000; 41:554–9.

15. Jay TB, Louis RK. Laparoscopic surgery of the kidney. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 9th ed.Philadelphia: Saunders;2007. 1762-9.

Fig. 1.

(A) Preoperative CT scan shows right hydronephrosis and perinephric stranding (arrow). (B) Intraoperative finding shows perinephric fibrosis (arrow).

Fig. 2.

Trocar position. PAL: posterior axillary line, MAL: mid axillary line, AAL: anterior axillary line.

Table 1.

Patient characteristics

	Group 1^∗	Group 2^†
No. of patients (n)	18	21
Mean age (years)	50±17	54±14
Male/Female	7/11	5/16
Laterality (Rt/Lt)	8/10	10/11
BMI (kg/m²)	24.43±9.68	25.16±10.45

^∗ : Group 1 were considered to had perinephric inflammation and adhesion on CT scan (perirenal strandings) and confirmed during operation,

^† : Group 2 had nonfunctioning kidneys without significant inflammation, Mean±SD, Rt: right, Lt: left, BMI: body mass index

Table 2.

Indications for nephrectomy

	Renal pathology	No. (%)
Group 1 (n=18)	Renal tuberculosis	11 (28)
	Xanthogranulomatous PN	3 (8)
	Pyonephrosis	2 (5)
	Renal abscess	2 (5)
Group 2 (n=21)	Chronic PN	12 (31)
	NFK with UPJ stricture	6 (15)
	Cystic disease	3 (8)
Total		39 (100)

PN: pyelonephritis, NFK: non-functioning kidney, UPJ: ureteropelvic junction obstruction

Table 3.

Perioperative parameters of 39 patients

Operative time (min)	166±55
EBL (ml)	453±253
Hospital stay (days)	8.2±2.9
Oral intake (days)	1.4±0.6
Ambulation (days)	1.3±0.5
Analgesics	PCA^∗
Complications
Major	1^†
Minor	4^‡

Descriptive statistics.

^∗ : patient controlled analgesia,

^† : unrecognized colon injury - subsequently required re-intervention on postoperative day 3,

^‡ : prolonged ileus, fever and wound infection (Mean±SD), EBL: estimated blood loss

Table 4.

Parameters of group 1 and group 2

Parameters	Group 1 (n=18)	Group 2 (n=21)	p-value
Operative time (min)	201±58	139±32	0.001^∗
Blood loss (ml)	610±280	351±147	0.001^∗
Hospital stay (days)	8.5±2.4	8.1±2.4	0.628
Ambulation (days)	1.3±0.5	1.5±0.5	0.670
Oral intake (days)	1.6±0.7	1.2±0.7	0.051
Complication (n)
Major	1	0
Minor	2	2

Student's t-test,

^∗ : statistical significance (Mean±SD)

TOOLS

Similar articles