Abstract
ABSTRACTObjectivesThis study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications.Materials and MethodsThirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined.ResultsAmong 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery.ConclusionsIn laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.
Highlights
Since laparoscopic nephrectomy was initially described by Clayman in 1991 [1], it has gained popularity for the treatment of a variety of benign and malignant kidney diseases
We introduced our clinical experience with an optimized procedure and the use of endovascular gastrointestinal anastomosis (EndoGIA) in laparoscopic nephrectomy for the management of inflammatory kidney diseases
A = the kidney with its perirenal fat was dissected outside the Gerota fascia; B = the renal pedicle was divided and ligated by EndoGIA
Summary
Since laparoscopic nephrectomy was initially described by Clayman in 1991 [1], it has gained popularity for the treatment of a variety of benign and malignant kidney diseases. Ibju | Laparoscopic nephrectomy for inflammatory kidney In such situations, laparoscopic nephrectomy was considered to be a challenging procedure for association with more complications, high probability of conversion to open surgery, bleeding, as well as injury to adjacent organ or large vessels. Some other urologists attempted to perform nephrectomy to treat inflammatory kidney diseases entirely by laparoscopy and modified operation skills; the operative time was still long and with a certain likelihood of conversion to open approach [7, 8]. We introduced our clinical experience with an optimized procedure and the use of EndoGIA in laparoscopic nephrectomy for the management of inflammatory kidney diseases. As far as we known, it is the first time that we classified the degrees of perinephric adhesions and based on which we predicted the difficulty related to laparoscopic nephrectomy for IRDs and optimized the procedures of nephrectomy
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