Laparoscopic Nephrectomy In Patients Research Articles

Quadratus lumborum block and transversus abdominis plane block in laparoscopic nephrectomy: a meta-analysis.

Aim: To study the efficacy of quadratus lumborum block (QLB) and transversus abdominis plane (TAP) in laparoscopic nephrectomy patients. Materials & methods: We conducted a meta-analysis of randomized controlled trials for QLB and/or TAP technique compared with each other or a control. Results: Direct analysis of 24h post-op pain score at rest for each compared with control showed significant reduction (QLB [mean differences, MD [95% CI]: -1.12 [-1.87,-0.36]; p=0.004) and TAP (MD [95% CI]: -0.36 [-0.59, -0.12]; p=0.003). With movement both were respectively lower than control (QLB (MD [95% CI]: -1.12 [-1.51, -0.72];p=<0.0001) and TAP (MD [95% CI]: -0.50 [-0.95, -0.05];p=0.03)). Moreover, QLB demonstrated less risk 24h of post-op nausea vomiting (PONV) versus control (PONV; RR [95% CI]: 0.64 [0.45,0.90];p=0.01). Conclusion: TAP and QLB reduce pain scores compared with control, whereas only QLB reduces PONV compared with control.

Laparoscopic nephrectomy for polycystic kidney disease: Benefit or necessity?

Background. According to foreign and domestic authors, autosomal dominant polycystic kidney disease (ADPKD) is a disease accompanied by a progressive deterioration in the functional state of the kidneys and occupies a significant contribution to the structure of all causes leading to the end stage of chronic renal failure (ESRD). An increase in the volume of the kidneys and the development of complications significantly worsen the quality of life of these patients. Open surgical interventions are accompanied by a more severe course. In this connection, the question of choosing the timing and method of surgical intervention in this group of patients remains relevant.&#x0D; Aim. To evaluate the results of nephrectomy in patients with ADPKD for the period from 2016 to 2022, performed at the Krasnoyarsk Regional Clinical Hospital.&#x0D; Materials and methods. Within 6 years, 22 nephrectomies were performed in 20 patients with ADPKD. Monolateral nephrectomy was performed in 12 cases, simultaneous bilateral surgery was performed in eight patients. The mean age of the patients was 51.3±7.9 years. Mostly nephrectomy was performed by laparoscopic approach (17 patients), lumbotomy operation was performed in three patients. The need for conversion during laparoscopic operations was not noted.&#x0D; Results. Open surgical treatment was performed only because of uncontrolled gross hematuria and suppuration of cysts. All patients were transferred to the intensive care unit after surgery. Repeated surgery due to the development of bleeding was required in 33.3% of cases. The need for an inpatient stage of treatment was 15.1±2.8 days. In one case, a fatal outcome was recorded. Laparoscopic nephrectomy was performed in 17 patients, monolateral in seven patients, staged bilateral in two, and simultaneous bilateral in eight patients. In 41% of cases, in addition to pain and hypertension, nephrectomy was due to the upcoming kidney transplantation. The average volume of removed kidneys was 3138.74±356.30 ml. The average bed-day was 8.86±2.4 days.&#x0D; Conclusion. The increase in the number of patients with ADPKD and ESRD raises the question of the improvement in their quality of life that can be achieved by unilateral or bilateral nephrectomy. However, there are no clearly regulated criteria that determine the indications for these types of surgery. Despite certain difficulties, we believe that laparoscopic nephrectomy in patients with ADPKD and ESRD is the most optimal.

#4691 LAPAROSCOPIC NEPHRECTOMY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract Background and Aims At the present, discussions continue on the indications and timing of performing kidney nephrectomy in patients with autosomal dominant polycystic kidney (ADPK) disease who are on the waiting list for kidney transplantation. Large sizes of kidneys, traumatic access, accompanying these operations cause a high incidence of postoperative complications, mortality and aggravate the severity of patients. The aim of the presented study was to find the preferred algorithm for preparing patients for kidney transplantation. Method The results of the nephrectomy of polycystic kidneys were analyzed in 28 patients (mean age 49±1.5 years, 16 men, 12 women), which were conditionally divided into two groups. The first group included 13 patients (46.4%) with open surgery using median laparotomy and lumbotomy, in the second group - 15 (53.6%) - laparoscopic nephrectomy. Surgical interventions for patients in both groups receiving renal replacement therapy dialysis, performed according to emergency and planned indications. Results The average duration of laparoscopic and open surgical interventions was 149±14 and 132±15 min, respectively. The maximum size of deleted polycystic-altered kidneys in the first group was 21.3±4.21 cm, in the second group it was 20.5±3.3 cm. The incidence of postoperative complications in the 1st and 2nd groups was 6 cases (46.1%) and 2 cases (13.3%), respectively. There was one fatal outcome (7.69%) in the 1st group as a result of septic complications. the average postoperative bed-day in the first group was 12-13 (12.7 ± 1.1), in the second - 8-9 (8.6±0.5). Patients after laparoscopic interventions are activated on the 2nd-3rd day (2.8±0.14), after open operations - on the 4th-5th (4.43±0.32). Conclusion The incidence of postoperative complications after laparoscopic nephrectomy in patients with ADPK does not exceed 13.3%. The use of laparoscopic technologies makes it possible to expand the possibilities of using nephrectomy for the treatment and preparation of patients with polycystic kidney transplantation.

Laparoscopic kidney resections in children with nephroblastoma (а literature review)

Introduction. Nephroblastoma is the third most common solid tumor in childhood, accounting for 7–8% of the total number of solid tumors in children. Currently, there is no unequivocal position of oncosurgeons regarding laparoscopic nephrectomy in patients with nephroblastomas; the cases described in the world literature are rare.Purpose. To find out the effectiveness of laparoscopic kidney resection in children with nephroblastoma.Materials and methods. The authors describe two clinical cases of laparoscopic nephrectomy in patients with nephroblastoma, including one-stage bilateral laparoscopic nephrectomy for bilateral nephroblastoma.Results. At the time of article writing, the two patients were in clinical and instrumental remission for 6 and 11 months, respectively.Conclusion. Indications for laparoscopic kidney resections in nephroblastoma: stage I, peripheral location of the tumor node with predominant extrarenal growth, response to chemotherapy, absence of the cystic component of the tumor.

A Helpful Tool in the Renal Surgery Armamentarium: Dorsal Lumbotomy nephrectomy for Tumor in Patients with End-Stage Renal Disease

ObjectiveTo compare operative outcomes between the dorsal lumbotomy (DL) and laparoscopic nephrectomy (LN) approaches for patients with end stage renal disease (ESRD) undergoing nephrectomy. DL operative technique is also described. Materials and methodsWe performed a retrospective review of all patients undergoing DL nephrectomy at Emory University from 2008-2020. Cases were matched with control patients with ESRD who had undergone LN. Parameters evaluated included operative time, estimated blood loss, length of stay, postoperative narcotic requirements, and complication rates. Statistical analysis performed with SPSS. Results43 DL patients and 86 LN patients were assessed. DL had shorter total OR time (173min vs 198min; P = 0.001) and surgery time (101min vs 135min; P<0.001) compared to LN. There was a trend towards decreased mean length of stay among the DL group (2.65d vs 3.14d; P = 0.069) as well as daily narcotic requirement measured in oral morphine equivalents (54.8mg/day vs 73.6mg/day, P = 0.051). There were no differences in estimated blood loss, perioperative complication rates, ICU admissions, or 30-day readmissions. Limitations include retrospective design and small sample size. ConclusionAmong patients with ESRD, DL was found to be safe and effective compared to LN, with shorter operative times, a trend towards decreased length of stay and post-operative narcotic requirements, and similar perioperative complication rates. DL should be considered as an approach for nephrectomy in this patient population.

Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

Aims:Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD.Patients and methods:We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes.Results:Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes.Conclusion:Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

Incidence and Associated Risk Factors of Venous Thromboembolism After Open and Laparoscopic Nephrectomy in Patients Administered Short-period Thromboprophylaxis: A Danish Nationwide Population-based Cohort Study

ObjectiveTo report the incidence of venous thromboembolism (VTE) after nephrectomy in Denmark and explore associated risk factors. Materials and MethodsA nationwide population-based retrospective cohort study was performed. All nephrectomies from January 2010 to August 2018 were assessed for postoperative VTE events. Univariable and multivariable analyses were used to evaluate the odds ratio (OR) of clinical variables’ effect on postoperative VTEs, within 4 weeks and 4 months after nephrectomy. ResultsIn 5213 nephrectomized patients, postoperative VTE incidence was 1% and 2% within 4 weeks and 4 months, respectively. Multivariable analyses revealed that predictors of postoperative VTE within 4 months were: open nephrectomy (OR 2.5, P = .001), history of VTE (OR 13.3, P <.001), length of hospital stay (OR 0.98, P = .02), and lymph node dissection (OR 2.0, P = .04). Limitations included the retrospective and registry-based study design and absence of individual patient data on patient body mass index and length of surgery. CONCLUSIONFor nephrectomy, postoperative VTE is rare. Open nephrectomy, history of VTE, length of hospital stay, and lymph node dissection are important risk factors which should be evaluated when tailoring VTE prophylaxis regimens.

Predictive Factors of Renal Function in Partial Laparoscopic Nephrectomy in Patients with a Kidney Tumor

Background: Laparoscopic partial nephrectomy has proven to be an ideal option for tumors in initial stages, preserving part of the renal parenchyma and reducing the possible risk of glomerular filtration decrease. Objectives: The main objective of this study is to determine the factors that can influence, to a greater extent, renal function deterioration after surgery. Methods: This is an observational, descriptive and longitudinal study. The renal funct ion was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and patients were divided into 2 groups depending on whether or not their renal function had been affected after surgery. We studied the correlation between the decrease of renal function and other variables. Results: The sample comprised 48 patients. In 30 of these cases, renal function had deteriorated after surgery. We observed a statistically significant relationship between the weight of the patient (p = 0.0230), size of the tumor (p = 0.0035), ischemic time (p = 0.0287), duration of the surgery (p = 0.0297), the RENAL score (p = 0.0230) and renal function deterioration. Conclusions: Partial laparoscopic nephrectomy is associated with a deterioration in renal function, where there is a decrease in glomerular filtration after surgery. The deterioration will depend on the weight of the patient, size of the tumour, ischemic time and duration of the surgery. The RENAL score can be used to predict said deterioration.

3D-технологии в планировании и навигации лапароскопических операций пациентов с конкрементами почек и мочеточника

to evaluate the possibilities and efficiency of using 3D technologies for the laparoscopic interventions in patients with renal and ureteric stones. A retrospective analysis of the results of surgical treatment of patients with renal and ureteric stones performed in the urology clinic of the I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia for the period from January 2012 to December 2017 was carried out. During this period a total of 4958 interventions were done. Among them, 98 laparoscopic (1.97%) surgeries were performed, including nephron-sparing interventions (n=47; 48%), pyelolithotomy (n=15; 15.3%), ureterolithotomy (n=32; 32.65%) and partial nephrectomy (n=4; 4.05 %). The average patients age was 55.76+/-10.5 (29-80) years. There were 51 men (52%) and 47 women (48%). The mean stone density was 1237.6+/-354.6 HU (from 500 to 1913 HU). In 14 (22.9%) cases, nephrostomy tube or ureteric stent had been put before surgery. In addition, 40 (40.8%) patients previously underwent one surgical intervention on the kidneys and 17 patients with urinary stone disease (17.3%) underwent surgery more or equal 2 times. 88 (89.8%) patients had severe concomitant diseases and the most common pathology in 51 (52.0%) patients with urinary stone disease was arterial hypertension. In 11 (11.2%) cases, the interventions were performed in patients with abnormal kidneys, including horseshoe kidney (n=6; 6.1%), duplicated collecting system (n=3; 3.1%) and pelvic kidney (n=2; 2%). In addition to standard preoperative diagnostic methods in 22 cases (22.4%) the 3D-planning and multivariate virtual performing of intervention based on the multidetector computer tomography scan was done using Amira 3D-modeling program. Among these patients, virtual interventions were performed prior to all pyelolithotomy and partial nephrectomy. Intraoperative data of virtual constructions were used by surgeons as navigation. The interventions were performed by seven urologists at the clinic with various experience in laparoscopic surgery. The mean duration of laparoscopic pyelolithotomy, laparoscopic partial nephrectomy, laparoscopic ureterolithotomy and laparoscopic nephrectomy was 183.2+/-69.6, 201.3+/-35.2 min, 97.6+/-43.7 and 165.4+/-92.3 min, respectively. The minimal blood loss was observed during laparoscopic ureterolithotomy (53.33+/-31.2 ml). During these interventions, in 8 cases (8.16%) a flexible endoscope was used for inspection and complete removal of stones. Intraoperative complications were noted in 6 patients (6.1%). There were 4 conversions to open surgery (4.1%). Postoperative surgical complications were observed in 1 (1%) patient, while non-surgical complications developed in 4 patients (4.1%). There was no mortality. Laparoscopic access for the treatment of patients with urinary stone disease should be used for the treatment of patients with large, long-standing ureteral calculi and patients with kidney stones who have concomitant pathology of kidney or upper urinary tract (UPJ obstruction, kidney tumors) requiring surgical intervention. Laparoscopic access should be considered primarily for the planning of laparoscopic partial nephrectomy and laparoscopic nephrectomy in patients with urinary stone disease. The use of 3D computer-assisted technologies is advisable for patients with urinary stone disease and abnormal kidneys if laparoscopic pyelolithotomy, partial nephrectomy or ureterolithotomy is planned.

Gasless laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease

Introduction. Autosomal dominant polycystic kidney disease (PKD) is one of the most common hereditary diseases leading to the development of end-stage renal failure. According to modern concepts, nephrectomy of polycystic-altered kidneys in such patients is performed in the event of complications, as well as in order to prepare for kidney transplantation. The creation of intense carboxyperitoneum leads to carbon dioxide resorption and the development of hypercapnia and respiratory acidosis in the patient. Taking into account the age of patients and the high incidence of cardiovascular and valvular pathology in patients with PKD, this fact becomes significant and can lead to the development of severe complications. The solution to this problem, in our opinion, is to perform laparoscopic nephrectomy under low-pressure carboxyperitoneum (LPC).&#x0D; Materials and methods. In the period from 2013 to 2018, 55 monolateral laparoscopic nephrectomies were performed in 36 patients with PKD. The study identified 2 groups of patients. The study group included 8 patients who were diagnosed at the preoperative stage with cardiovascular disease performed LPC (12 operations). The second group was represented by 28 patients who were operated laparoscopically with the creation of intense carboxyperitoneum (41 operations). Workspace when LPC was created with the help of laparolift – mechanical device for lifting the abdominal wall on the abdominal cavity.&#x0D; Results. The mean duration of surgery in the groups was 126 ± 18 and 114 ± 11 minutes, respectively (p &lt; 0.05). Intraoperative blood loss was significantly different: in the comparison group – 225 ± 45 ml, in the study group – 440 ± 76 ml (p &lt; 0.05). Mean blood pCO2 and pH levels in the study group were 38.2 ± 2.7 mm Hg and 7.371 ± 0.021, the comparison group – 44.4 ± 3.8 mm Hg and 7.231 ± 0.035 (p &lt; 0,05). Among the patients who underwent LPC, there was one fatal outcome. The frequency of postoperative complications was 16.6% (2) in the study group and 12.2% (5) in the comparison group.&#x0D; Summary. Laparoscopic nephrectomy in conditions of low pressure carboxyperitoneum allows to completely avoid the development of hypercapnia and respiratory acidosis in the patient, to prevent severe cardiovascular complications despite the high risk of their development among patients with PKD.

Is transperitoneal laparoscopic radical nephrectomy suitable for patients with a history of abdominal surgery?

Laparoscopic radical nephrectomy is the gold standard for treatment of renal cell carcinoma. However, previous abdominal surgery is generally regarded as a contraindication to the laparoscopic approach because it causes intraperitoneal adhesions, which are thought to interfere with subsequent laparoscopic procedures inside the abdominal cavity. Few studies have examined the influence of prior surgery on laparoscopic nephrectomy. Therefore, the aim of this study was to evaluate the impact of previous laparotomy on laparoscopic nephrectomy. The records of 251 consecutive patients who had undergone laparoscopic nephrectomy for renal cell carcinoma at our hospital between 2005 and 2015 were reviewed retrospectively. Of the 251 laparoscopic nephrectomy patients, 76 patients (30%) had undergone prior abdominal surgery (surgery group), whereas the remaining 175 patients (70%) had not previously had abdominal surgery (control group). There were no significant differences between the control group and the surgery group with regard to pneumoperitoneum time (143 vs 135 min, P = 0.241) or blood loss (39 vs 36 mL, P = 0.763). Next, we divided the patients into two cohorts based on surgeon experience: 98 patients had been treated by an expert (i.e. someone who performs more than 50 laparoscopic procedures per year) and 153 patients had been treated by a non-expert. There was no significant difference in pneumoperitoneum time between the control and surgery groups in each cohort (treated by experts, 108 vs 103 min; treated by non-experts: 162 vs 166 min). We conclude that laparoscopic nephrectomy may be feasible after previous abdominal surgery and could be one of the surgical options.

Pushing the Envelope: Laparoscopic Nephrectomy as Outpatient Surgery.

The purposes of this review were to identify the possible limiting factors prohibiting laparoscopic nephrectomy being performed as an outpatient surgery and optimize these limiting factors. Laparoscopic nephrectomy for patients who have kidney cancer can be performed as an outpatient surgery in well-selected, well-educated, and well-informed patients in a well-prepared hospital culture. Patient confidence, pain, and hospital culture are the most important limiting factors to the performance of laparoscopic nephrectomy as an outpatient procedure. Controlling these factors leads to a high success rate for the outpatient procedure.

The use of laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease

The study analyzed the results of treatment of 32 patients with autosomal dominant polycystic kidney disease (PKD). In the period from 2014 to 2016 these patients underwent nephrectomy for clinical indications and in preparation for renal transplantation. The first group (15 patients) performed open surgery using midline laparotomy and lumbotomy (16 operations), of which: bilateral nephrectomy - 11 (68.7%), monolateral nephrectomy - 5 (31.3%). In the second group (17 patients) to perform a monolateral nephrectomy used laparoscopic transabdominal access (24 operations). The average duration of laparoscopic and open surgical interventions were not significantly different and amounted to 146 ± 14 and 134±15 min (p > 0.05). The maximum size of the deleted polycystic-changed kidneys in the first group amounted to 22.5 ± 4.27 cm, in the second of 21.5 ± 3.9 cm (p > 0.05). The frequency of postoperative complications in the first and second groups consisted of 43.75% and 12.5%, respectively. Was observed in 1 (6.25%) case of lethal outcome in the first group. Average postoperative hospital stay in the first group 13-14 (to 13.7 ± 1.3), in the second - 7-8 (7.6 ± 0.4, p < 0.05). Patients after laparoscopic procedures activated in 2-3 days (2.5 ± 0.13) after open procedures on 4-5 (4.13 ± 0.39, p < 0.05). Laparoscopic technology can significantly reduce the frequency of postoperative complications and increase the possibility of the use of nephrectomy in the treatment of patients with PKD. Laparoscopic transabdominal approach is characterized by a more favorable course of the postoperative period after nephrectomy, can reduce the duration of inpatient treatment and to activate patients in the early stages.

Comparison of transperitoneal laparoscopic nephrectomy outcomes in atrophic and hydronephrotic kidneys.

To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys. Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre-and post-operative hemoglobin and creatinine values, transfusion rates and length of hospital stays. Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups. Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys.

Laparoscopic nephrectomy for autosomal dominant polycystic kidneys in patients with end-stage renal disease on maintenance hemodialysis: 10-year single surgeon experience from an Indian center.

CONTEXT:Pure laparoscopic nephrectomy in patients with ADPKD (autosomal dominant polycystic kidney disease) and ESRD (end-stage renal disease) on MHD (maintenance hemodialysis) is challenging with high incidence of complications. Limited experiences from India has been reported in these scenarios.AIMS:To present a 10-year single surgeon experience from India in laparoscopic nephrectomy in autosomal dominant polycystic kidneys (ADPKD) and end-stage renal disease (ESRD) on maintenance hemodialysis (MHD).SETTINGS AND DESIGN:Retrospective.MATERIALS AND METHODS:Retrospective analysis of records of similar subset of patients who were offered laparoscopic nephrectomy between 2003 and 2012. Preoperative, operative and postoperative parameters were recorded. Few technical modifications were adopted over the years. Patients were sub-classified into two groups (Group I: 2003–2006, Group II: 2007–2012) based on surgical technique.STATISTICAL ANALYSIS USED:SAS software 9.1 version.RESULTS:75 patients (84 renal units, Group I: 31, Group II: 53) were included in this analysis. Unilateral procedure was performed in 66 and bilateral staged or simultaneous procedure in 9. Despite larger kidneys in Group II (mean longitudinal renal length 25.7 ± 3.4 vs 17.5 ± 2.7 centimeters, P <0.001), improved operative and postoperative profile were noted in Group II in several parameters-mean total operative time (205 ± 11.5 vs 310 ± 15.3 min, P = 0.00), time for specimen retrieval (30.5 ± 3.5 vs 45 ± 4.1 min, P = 0.02), postprocedure drop in hemoglobin (1.1 ± 0.1 vs 2.27 ± 0.03 grams/deciliter, P = 0.00). Conversion rates, intraoperative and postoperative events were also considerably less in Group II.CONCLUSIONS:Despite existence of comorbidities and technical difficulties, laparoscopic nephrectomy in patients with ADPKD with ESRD and on MHD is a feasible option. Technical modifications with increasing surgeon's experience allows successful conductance of this approach in more complex cases with better outcome.

S176: How safe is laparoscopic nephrectomy in patients with stage 3 or 4 renal cell cancer

S176: How safe is laparoscopic nephrectomy in patients with stage 3 or 4 renal cell cancer

Néphrectomie laparoscopique pour reins polykystiques : principes et résultats

To evaluate the feasibility and morbidity of laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPK). This is a retrospective multi-centre study (University Hospitals of Lyons, Toulouse, Nantes and Rennes). Sixty-eight patients who had undergone laparoscopic nephrectomy for polycystic kidney disease between November 1999 and May 2009 were included. This involved unilateral nephrectomy 64 cases, one-stage bilateral in one case and two-stage bilateral in three cases. The mean operating time was 218±74min (100-420) Conversion was necessary in 7 cases. The mean weight of the removed kidney was 1291±646g (240-3400). We regret to report 20 postoperative complications, including one death on postoperative day 50, following an abscess in the renal pelvis, 6 retroperitoneal haemoatomas and 5 arteriovenous fistula thromboses. Postoperative analgesia involved PCA treatment with morphine for a mean period of 1.59±0.8 days (0.5-4). The mean length of hospital stay was 8.3±6.1 days (3-50). This study shows the feasibility of the laparoscopic approach for nephrectomy in ADPK. This procedure should be performed by experienced laparoscopic surgeons. Indeed, the complication rate is moderate but there is still a risk of severe complications. 5.

Simultaneous Kidney Transplantation and Bilateral Native Nephrectomy for Polycystic Kidney Disease

Bilateral native nephrectomy with simultaneous kidney transplantation is becoming more common for patients with polycystic kidney disease in the living donor nephrectomy era. Single center reports evaluating the short-term and long-term outcomes of simultaneous kidney transplantation have been published but are generally limited by small sample sizes. We examined population level data to broadly define the complications of simultaneous kidney transplantation. The Nationwide Inpatient Sample (NIS) was used to acquire data on 2,368 patients with polycystic kidney disease treated with bilateral native nephrectomy between 1998 and 2010. We performed unadjusted, multivariable and propensity score adjusted analyses of postoperative outcomes. A total of 2,368 patients were included in this study. The 271 patients (11.4%) who underwent simultaneous kidney transplantation had higher rates of intraoperative hemorrhage, blood transfusion and urological complications (propensity score adjusted OR 3.3, p=0.01, OR 4.2, p<0.0001 and OR 5.5, p<0.0001, respectively) but a lower in-hospital mortality rate (15.8% vs 1.1%, propensity score adjusted OR 0.10, p<0.0001). Median hospitalization was also significantly higher in patients who underwent simultaneous kidney transplantation (6 vs 9 days, p<0.0001). For the top quartile of high volume hospitals the rates of intraoperative hemorrhage, blood transfusion and urological complications remained statistically higher in patients treated with simultaneous kidney transplantation but in-hospital mortality was similar on multivariable logistic regression (OR 0.2, p=0.17). Except for increased rates of intraoperative hemorrhage, blood transfusion and urological complications there were no significant differences in postoperative adverse outcomes in this large, population based study of patients who underwent simultaneous kidney transplantation compared to bilateral native nephrectomy alone.

Transperitoneal Laparoscopic Radical Nephrectomy in a Patient With Severe Scoliosis

To report the first case of a left transperitoneal laparoscopic nephrectomy in a patient with a severe left convex lumbar scoliosis and to elaborate on the technical difficulties of this procedure. The surgical procedure was performed by an experienced laparoscopic surgeon after rigorous pre-operative visualization of the altered visceral and vascular abdominal anatomy. A transperitoneal laparoscopic approach with an open introduction technique according to Hasson and a caudo-cranial dissection of the left renal hilum were performed to prevent major vascular and visceral injury in this challenging surgical procedure. The operation time was 102 minutes and the estimated blood loss was 100 mL. The surgeon was able to complete the transperitoneal laparoscopic radical nephrectomy without complications. Transperitoneal laparoscopic radical nephrectomy in patients with severe spinal deformities is feasible, but should only be performed by experienced laparoscopic surgeons to ensure patient safety and cancer control.

La néphrectomie laparoscopique pour rein polykystique est faisable et reproductible

The aim of our study was to report our experience of laparoscopic nephrectomy in patients with polycystic kidney disease.Between December 2007 and February 2012, we performed 39 consecutive laparoscopic nephrectomies in patients with polycystic kidneys. All patients were operated by a transperitoneal approach.Patients had a mean age of 55 with an average BMI of 25 kg/m(2). Eighty-seven percent were ASA III and 77% were on dialysis. In most of the cases, the indication concerned patients who were candidates to a renal transplantation to make space for graft implantation. Operative time was 167 minutes with a mean blood loss of 200 mL. Two open conversions were necessary (splenic injury and difficulty of dissection of the renal pedicle). Fifteen percent of patients were transfused. There were 11 complications (28%) among which five were major (Clavien ≥ 3). Mean length of stay was 5.2 days.Our study showed that laparoscopic nephrectomy for polycystic kidney is feasible and reproducible. We systematically offer it when indicated.