Laparoscopic Simple Nephrectomy Research Articles

Univariate analysis for prediction of factors affecting outcome of laparoscopic simple nephrectomy

Univariate analysis for prediction of factors affecting outcome of laparoscopic simple nephrectomy

Univariate analysis for prediction of factors affecting outcome of laparoscopic simple nephrectomy

Univariate analysis for prediction of factors affecting outcome of laparoscopic simple nephrectomy

Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis: A singlecenter analysis of outcomes and predictors of surgical approaches and complications.

The aim of this study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications. We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy (ON) or laparoscopic simple nephrectomy (LN) from January 2014 to April 2020. The primary endpoint was the evaluation of perioperative outcomes and complications. Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications. Overall, 44 out of 67 patients (65.67%) underwent ON, while 23 (34.33%) underwent LN. Patients in the ON group experienced more postoperative pain according to the visual analogic scale (p = 0.032). Moreover, time to deambulation and time to return to full daily activities, assessed according to the 12-Item Short Form Survey physical and mental component summary scores questionnaires, were significantly shorter in the LN group (p = 0.021, p < 0.001, and p < 0.001, respectively). Of note, there were no significant differences in intraoperative and postoperative complication rates among the groups (p = 0.258 and p = 0.317, respectively). No conversion to open surgery was described. Logistic regression analysis demonstrated that urgency (p = 0.025) was the only predictor associated with a higher risk of intraoperative complications. However, no independent factors associated with postoperative complications or with the surgical approach of choice were found. Based on our results, laparoscopic treatment of XGP represents a feasible alternative to ON, resulting in less postoperative pain and faster recovery. In skilled hands, LN should be considered as the treatment of choice for XGP.

Laparoscopic nephrectomy in patients with renal exclusion secondary to urolithiasis. Which factors can predispose conversion to open surgery?

The prevalence of urolithiasis is 7-10% and has increased over the past years. Simple nephrectomy is, therefore, indicated when renal exclusion is associated with recurrent urinary tract infections and/or chronic pain. The aim of the study was to describe the surgical experience of laparoscopic nephrectomy (LPN) due to urolithiasis in Mexican South-east and which factors can predispose conversion to open surgery. This was a retrospective study including patients with renal exclusion secondary to urolithiasis, who underwent laparoscopic simple nephrectomy between 2016 and 2019. Forty simple LPN for renal exclusion due to urolithiasis was performed between 2016 and 2019. Mean age was 47 ± 10.8 and 82.5% were female. The mean BMI was 30.2 ± 5 kg/m2, mean operative time was 165.2 ± 64. Conversion rate was 12.5% (n = 5). Conversion was significantly associated with abnormal hilum vascular anatomy (p = 0.001), hilum adherences (p = 0.001), and hydronephrosis (p = 0.001). LPN is a safe surgical technique for renal exclusion due to urolithiasis. Hydronephrosis, abnormal vascular anatomy, and the adherences that involved de hilum are the factors that could predictive conversion to open surgery.

A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database

Objectives: While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database. Patients and methods: All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed. Results: Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss ( p = 0.001), transfusion rate ( p = 0.02) and operative length ( p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy ( p = 0.02), nephroureterectomy ( p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach. Conclusion: Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon. Level of evidence: 4

Primary adenocarcinoma of renal pelvis or ureter: an uncommon histopathological entity seen in three cases

BackgroundPrimary adenocarcinoma of renal pelvis or ureter is rarest (< 1%) among all urothelial tumors. Regrettably, no characteristic symptoms, radiological features and treatment for this tumor are reported. We report three cases of adenocarcinoma of renal pelvis and ureter.Case presentationCase 1 had grossly hydronephrotic non-functional right kidney and underwent percutaneous nephrostomy followed by laparoscopic simple nephrectomy. Incidentally, histopathological examination reported adenocarcinoma of renal pelvis. Whole-body positron emission tomography-CT (PET-CT) ruled out malignancy at other sites. Patient refused adjuvant chemotherapy. Case 2 presented with previous history of right pyelolithotomy, right ureteroscopic lithotripsy and right flank pain with intermittent discharge via previous percutaneous site. On biochemical and radiological investigations, right poorly functioning pyonephrotic kidney was confirmed. Patient underwent right open nephrectomy which incidentally reported adenocarcinoma of renal pelvis. Patient is disease-free at 18 months of follow-up. Case 3 had left ureteric wall thickening on CT scan when evaluated for hematuria. Ureteroscopic-guided biopsy showed villous adenoma. Laparoscopic left nephroureterectomy with bladder cuff excision specimen showed well-differentiated adenocarcinoma in ureter with extension into periureteric fat. Patient died 32 months after surgery.ConclusionPrimary adenocarcinoma of renal pelvis or ureter is very rare and urologists should suspect it in patients with mucinous material in nephrostomy tube. We should have a low threshold for performing radical nephrectomy with complete ureterectomy in these unusual cases to improve the prognosis.

634 Review of Nephroureteric Surgical Service in a District Urological Center

Abstract Background New Cross hospital has been offering radical/partial nephrectomy, nephro-ureterectomy for cancer patients and simple nephrectomy for non-functioning kidney with availability of robotic system facilities since 2016. Methodology Retrospective analysis of data collected prospectively between January 2019 and September 2019. All patients underwent nephrectomy/nephroureterectomy and their demographic, comorbidities and surgical outcomes data analysed. Results 7 underwent lap robotic nephroureterectomy, 27 underwent laparoscopic radical nephrectomy, 4 underwent laparoscopic simple nephrectomy, compared to total of 13 combined cases in 2018. FtM ratio- 1:1.92(13:25). Mean cohort age 64. Mean cohort BMI is 28.3. Mean pre-op HB is 132.9. Average op time for nephroureterectomy is 247 minutes, nephrectomy is 108.2 minutes. Average blood lost is 70mls, no patient of the cohort required any blood transfusion. 1 case sustained splenic laceration had surgical repair, 1 case was abandoned due to extensive bowel involvement. No cases required conversion from laparoscopic to open procedure. Post operatively, 1 patient developed VT, 1 patient had subcut haematoma, Average increase in serum creatinine is 42, and average Hb drop is 10.7. Average admission period were 3.7 days. Conclusions Our urological centre manage to perform more laparoscopic nephroureteric procedures as compare to previous year without much decline in terms of patient surgical outcome.

Challenges in Laparoscopic Simple Nephrectomy of Non-functioning Kidneys Due to Urolithiasis

Challenges in Laparoscopic Simple Nephrectomy of Non-functioning Kidneys Due to Urolithiasis

Laparoskopik ve Açık Basit Nefrektomi Yapılan Hastaların Klinik ve Operatif Özelliklerinin Değerlendirilmesi

Laparoskopik ve Açık Basit Nefrektomi Yapılan Hastaların Klinik ve Operatif Özelliklerinin Değerlendirilmesi

Mini- Laparoscopic Simple Nephrectomy Critical Assessment through A Randomized Trial

Background: The conversion from open to laparoscopic simple nephrectomy was considered as an initial and most dramatic step toward progression, the second step is trying to miniaturization of the endoscope and instruments, in this study we aimed to evaluate miniaturization of laparoscopic simple nephrectomy looking for reduction perioperative morbidity and enhance cosmoses without significant operative disability. Patient and Methods: We prospectively reviewed 120 patients (60 in each group) who underwent trans-peritoneal conventional laparoscopy (CL) or mini laparoscopy (ML) simple nephrectomy between April 2015 and May 2018. The CL was done using 3 to 4 ports ranged from 5 to12 mm in diamond manner distribution. ML was done using same ports number and distribution ranged from 3- 5 mm except umbilical one was 10 mm. All operations were performed by same surgeon Results: However, ML experienced a significant longer operative time, significant more blood loss and insignificant increased conversion rate. The Post-operative data in the interest of ML were as follows; significantly lower pain scores, lower hospital stay, earlier return to activities and significant increase of cosmoses score of patients, Lastly, port site hernia was 6.7% in CL group and none in ML group (p = 0.042) Conclusion: ML trans-peritoneal simple nephrectomy is associated with lower post-operative pain, hospital stay, early return to normal activity, better cosmoses and less port site hernia. However operative time, blood loss and conversion rate are potentially more than CL.

Laparoscopic and robotic specimen retrieval system (Modified Nadiad Bag): Validation and cost-effectiveness study model.

Aim:To construct and validate a cost-effective indigenously made retrieval system (Modified Nadiad bag) in minimal access urology.Method:The components of the modified Nadiad bag are a polyethylene roll, fishnet thread, and a 5 Fr ureteral catheter. The bag is indigenously made in our institute and used for organ retrieval after proper sterilization. The video recordings of entrapments and retrievals done over the past few months were reviewed. The procedures under review in which the bag was used were: Robot Assisted Radical Prostatectomy (50 cases), laparoscopic radical nephrectomy (50 cases), laparoscopic simple nephrectomy (50 cases) and laparoscopic adrenalectomy (18 cases). We also compared the retrieval time with experts and novices.Results:The retrieval times, the organ size (largest dimension) and specimen weight were records for each case. Multivariate analysis of the data was done and we extrapolated the retrieval time with organ size, specimen weight and expertise of the surgeon. There was no significant difference among expert surgeons and novice surgeons with regards to retrieval times (p value = 0.29), with regards to organ size (p value = 0.83) and with regards to specimen weight (p value = 0.99).Conclusion:Our design of retrieval system offers a cost-effective option which is easy to make, without the risk of tumor seeding and without the need for separate access sheath. It's a retrieval system which has proved its efficacy in laparoscopic as well as robotic procedures with no bearing on the expertise of the surgeon involved.

Laparoscopic Transperitoneal Nephrectomy in Non-functioning Severe Hydronephrotic Kidneys With or Without Renal Stone.

AimTo investigate the effects of the additional presence of nephrolithiasis on the results of laparoscopic simple nephrectomy in patients with severe hydronephrotic non-functional kidneys.Patients and methodsA total of 43 patients in whom severe hydronephrosis had been determined on spiral computerized tomography, who had a renal function of lower than 10% according to the dimercaptosuccinic acid (DMSA) renal scintigraphy, and who had undergone a laparoscopic simple nephrectomy due to persistent renal pain and/or recurrent urinary tract infection and/or unresolved hypertension with multidrug treatment, were included in the study. The patients were divided into two groups based on the presence of renal stone as those with stone formation (Group 1) and those without stone formation (Group 2). The groups were compared with regard to the patients’ demographic characteristics, operation durations, pre- and postoperative hemoglobulin and creatinine levels, percentage of change of postoperative hemoglobulin levels, complications, transfusion requirements, and durations of hospitalization.ResultsOverall, there were 43 patients including 19 patients in Group 1 and 24 patients in Group 2. Although the durations of operations, the durations of hospitalization, and the rates of change of hemoglobulin were higher in the patients in Group 1, these differences were not statistically significant. Postoperative complications were observed in 21 (48.8%) of the 43 patients. Postoperative complications were observed in 13 patients in Group 1 and in eight patients in Group 2. This difference was determined to be statistically significant (p<0.01).ConclusionsWe observed that except for the postoperative complication rates, the laparoscopic nephrectomy results in patients with severe hydronephrotic non-functional kidneys with or without stone were similar.

Effect of Esmolol and Diltiazem Infusions on Hemodynamic Response to Pneumoperitoneum on Laparoscopic Simple Nephrectomy: A Randomized Controlled Trial.

Background:Several studies have been conducted in search of appropriate drugs to attenuate hemodynamic responses in laparoscopic cholecystectomy, but till date, no such study has been conducted on patients undergoing laparoscopic nephrectomy.Aim:The study was designed to assess the effect of esmolol and diltiazem infusions on hemodynamic changes during routine laparoscopic transperitoneal simple nephrectomy.Settings and Design:A prospective double-blinded randomized control trial.Subjects and Methods:A total of 120 nonhypertensive patients of the American Society of Anesthesiologists physical Status I and II aged 20–60 years about to undergo laparoscopic nephrectomy were enrolled for the study after obtaining Institute Ethical committee approval. The patients were randomly allocated to one of the three groups. Group I (control group) received 10 ml normal saline intravenously (i.v.) before induction of anesthesia, followed by continuous infusion 10–20 ml/h. Group II (esmolol group) received i.v. esmolol 1 mg/kg diluted in 10 ml similarly, followed by continuous infusion of 10–20 ml/h (5–10 μg/kg/min). Group III (diltiazem group) received i.v. diltiazem 0.2 mg/kg diluted in 10 ml before induction of anesthesia, followed by continuous infusion at 10–20 ml/h (0.08–1.25) μg/kg/min. After completion of surgery, all the infusions were stopped. Data recording were done for changes in hemodynamics throughout the surgery.Statistical Analysis:was done using Chi-square test for categorical data and one-way ANOVA for continuous data. Tukey (“honestly significant difference”) post hoc test was applied for intra- and inter-group comparison in cases where ANOVA was significant. P < 0.05 is considered statistically significant.Results:All hemodynamic data: Heart rate (HR), systolic, diastolic, and mean arterial pressure were observed to be significantly higher (P < 0.001) from baseline in control group at the time of creation of pneumoperitoneum, till 20 min thereafter. The values were comparable to baseline in both esmolol and diltiazem group. On intergroup comparison, the patients in esmolol group had significantly lower HR and blood pressures than in diltiazem group at the creation of pneumoperitoneum and at extubation (P < 0.05). Mean dose of esmolol and diltiazem used were 7.25 ± 1.33 μg/kg/min and 1.14 ± 0.77 μg/kg/min, respectively.Conclusion:Both esmolol and diltiazem infusion provide stable intraoperative hemodynamics and protection against stress response triggered by pneumoperitoneum in patients undergoing laparoscopic transperitoneal nephrectomy.

Laparoscopic transperitoneal and retroperitoneal simple nephrectomy: The impact of etiological factors of the results of surgical treatment.

This retrospective study compares the perioperative outcomes of laparoscopic simple nephrectomy (LSN) in patients with urinary stone disease (USD) in comparison with LSNs performed for other etiological factors. 115 LSNs were identified from the two teaching hospitals' database. Depending on the etiological factors, patients were stratified in 2 groups. Group 1 consisted of 63 (mean age 44.8±1.7 [21-71] years) patients; where the cause of non-functioning kidney was USD. Meanwhile, Group 2 included 52 (mean age was 43.6±2.0 [19-78] years) patients; who underwent LSN because of other benign diseases. In both groups, a standardized transabdominal or retroperitoneal approach was used according to the discretion of the attending surgeon. Two groups were compared statistically in terms of perioperative parameters and standardized surgical complications. The use of transperitoneal approach was higher in Group 1 (69.8% vs. 30.2%) compared to Group 2 (51.9% vs. 48.1%). Elective open conversion was needed in 3 and 2 patients in Groups 1 and 2, respectively. The results for mean operative time (108.9±4.0 min vs. 106.7±5.0), estimated blood loss (92.5±8.2 vs. 86.8±10.1 mL) and length of hospital stay (4.1±0.33 vs. 3.85±0.42 days) were similar between the groups. Despite intraoperative complications were similar between the groups, overall post-operative complications were significantly higher (17.5% vs. 3.8%) in Group 1. However, the rate of significant complications (Clavien 3-5) was similar between the groups. The present study revealed that perioperative outcomes of patients undergoing LSN for USD are similar to those seen in patients undergoing LSN for other etiological factors.

Intraoperative finding of Falope ring over ureter as a cause of nonfunctioning kidney during laparoscopic simple nephrectomy

Intraoperative finding of Falope ring over ureter as a cause of nonfunctioning kidney during laparoscopic simple nephrectomy

Does laparoscopic transperitoneal simple nephrectomy for inflammatory and non-inflammatory kidneys differ?

BackgroundLaparoscopic simple nephrectomy is the standard procedure for the removal of non-functioning benign kidney. It can be performed transperitoneally or retroperitoneally. There are several studies comparing the results of transperitoneally or retroperitoneally laparoscopic nephrectomy but there are limited numbers of study comparing results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys. The aim of this study was to compare the results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys.ResultsWe retrospectively reviewed the records of patients who underwent laparoscopic nephrectomy for various inflammatory and non-inflammatory renal conditions at our institution from May 2012 to October 2015. We divided the patients in two groups. Group 2 involved the kidneys with stone disease and/or hydronephrosis, patients with previous renal surgery and patients with the history of recurrent infections. Group 1 involved the patients who had non-functioning kidney without these properties. All the surgeries were performed by transperitoneal approach and peroperative blood loss, operation time, hospitalization time, postoperative creatinine changes and haemoglobin drop were compared between groups. There were 22 patients with inflammatory and 27 patients with non-inflammatory non-functioning kidney. Operation time, peroperative blood loss, hospitalization time, postoperative haemoglobin drop and creatinine difference were not statistically different between groups. Surgical side and the presence of previous surgery did not affect the surgical results of inflammatory and non-inflammatory kidney nephrectomy. The only difference was postoperative fever which was more frequent after the nephrectomy of inflammatory kidney.ConclusionsOn the basis of our experience, surgical results of transperitoneal laparoscopic simple nephrectomy did not differ between inflammatory and non-inflammatory kidneys. Surgical times were higher in inflammatory group even if the difference was not significant.

Impact of Obesity on Complications of Laparoscopic Simple or Radical Nephrectomy

Objective: To determine the impact of obesity on complications in laparoscopic simple or radical nephrectomy. Patients and Methods: The medical files of 215 patients who underwent laparoscopic simple or radical nephrectomy in our center between 2004 and 2014 were reviewed. A body mass index of 30 kg/m² was used to divide the patients into obese and non-obese groups. Pre-operative data and intra- and post-operative complications were compared between the 2 groups. Results: There were respectively 163 and 52 patients in the non-obese and obese groups, which were comparable in terms of age, sex, and history of surgery. In the obese group, operative specimens were significantly heavier (772 vs. 534 g in the non-obese group; p = 0.005) and durations of surgery was significantly longer (244 vs. 216 minutes; p = 0.003). However no significant differences were found between the 2 groups for duration of hospitalization, surgical conversion, estimated blood loss, or intra- or post-operative complications. Conclusion: Laparoscopic simple or radical nephrectomy is technically feasible in obese patients but the surgery may take more time, notably due to dissection difficulties. Our results showed that the risk of intra- and post-operative complications is not higher in obese patients compared to non-obese patients, except for a possible, but statistically undemonstrated, higher risk of abdominal wall complications, and that the laparoscopic approach should be the preferred technique in patients with high body mass index.

Laparoscopic simple nephrectomy patient with situs inversus totalis and left renal hypoplasia: A case report.

Situs inversus totalis (SIT) is a relatively rare anatomical condition characterized by the transposition of thoracic and abdominal organs from the normal side to the opposite position. Most reports of laparoscopic procedures in patients with SIT cite technical difficulties and longer operative times due to disorientation because of the reversed abdominal organs and necessary modification of the surgeon's movements and techniques. We present a case of a patient with SIT in whom a transperitoneal laparoscopic simple nephrectomy was performed.

Prospective study of preoperative factors predicting intraoperative difficulty during laparoscopic transperitoneal simple nephrectomy.

Objective:To prospectively study and identify, the preoperative factors which predict intraoperative difficulty in laparoscopic transperitoneal simple nephrectomy.Patients and Method:Seventy seven patients (41 males and 36 females) with mean age of 43 ± 17 years, undergoing transperitoneal laparoscopic simple nephrectomy at our institute between February 2012 to May 2013 were included in this study. Preoperative patients' characteristics recorded were: Gender of patients, history of intervention, palpable lump, BMI, urine culture, side, size of kidney, fixity of kidney on USG, perinephric fat stranding on preoperative CT scan, periureteral fat stranding, perinephric collection, enlarged hilar lymph nodes, renal vascular anomalies, differential renal function on renogram. Preoperative factors of these patients were noted and intraoperative difficulty in the surgery was scored between 1 (easiest) to 10 (most difficult or open conversion) by a single surgeon (who was a part of all studies either as operating surgeon or assistant). Using SPSS 15.0 software, multivariate and univariate analysis was done.Results:In multivariate analysis presence of pyonephrosis on preoperative evaluation and BMI < 25kg/m2 were found to be statistically significant factors predicting intraoperative difficulty during laparoscopic simple nephrectomy. On univariate analysis following factors were associated with increased surgeon's score: Lower BMI, palpable kidney, pyonephrosis, history of renal intervention, perinephric fat stranding, right side, fixity of kidney on USG with surrounding structures.Conclusion:Our findings suggest that presence of pyonephrosis as identified on preoperative imaging and a BMI of less than 25 Kg/m2 are the most significant factors predicting intraoperative difficulty during laparoscopic simple nephrectomy.

Comparison of Retroperitoneal &amp; Transperitoneal Laparoscopic Nephrectomy in Management of Pyonephrosis in Terms of Conversion to Open Surgery

Introduction: Since the mid-1990s, there has been an evolution in surgical practice from traditional open approaches to minimally invasive means of treating operative lesions. This study is carried out to study rate &amp; indication of conversion to open surgery in pyonephrosis using retroperitonel and trans peritoneal laproscopic nephrectomy. Materials And Methods: This study was retrospective study done in Department of Urology Civil hospital &amp; B J Medical College Ahmadabad .We performed a retrospective review of a maintained database of 219 consecutive laparoscopic simple nephrectomies done for pyonephrosis between July 2001 to February. 2013. Results: In study transperitoneal route using four ports was used in 165 (75.3%) while retroperitoneal access using three was used in 54(24.6%) patients. In our study total 163 (74.4%) had PCN (percutaneous nephrostomy) in situ, 79.3% in lap transperitoneal group and 59.2% in lap retro peritoneal group. 27(12.3%) patients required conversion to open surgery. Adhesion 13(5.9%) and bleeding 9(4.1%) were the main factors for conversion, while 2 (0.9%) patients required conversion due to bowel injury and limited space in 3(1.3%) patients. Conversion rate was 12.1 % (20/165) for transperitoneal procedures while 12.9 % (7/54) for retroperitoneal approach. Laparoscopic approach requires proper placement of ports for meticulous surgical dissection. Preoperative plain and CECT help in identifying renal hilar anatomy as well as the relationship with the surrounding structures. Conclusion: In our study, retroperitoneal laparoscopic nephrectomy has to be considered equal to transperitoneal laproscopic nephrectomy in terms of conversion to open surgery.