Retroperitoneoscopic Nephrectomy Research Articles

Comparative analysis of postoperative complications of the open, laparoscopic and retroperitoneoscopic nephrectomy

Comparative analysis of postoperative complications of the open, laparoscopic and retroperitoneoscopic nephrectomy

Long-Term Oncological Efficacy of Retroperitoneoscopic Radical Nephrectomy of Localized Renal Cell Cancer pT1-3 (≤12 cm).

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SC149 - Retroperitoneoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD): results of an initial series

SC149 - Retroperitoneoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD): results of an initial series

Retroperitoneoscopic Nephrectomy in Pediatric Patients.

Minimally invasive surgery (MIS) in pediatric population is becoming more and more popular among pediatric urologists and now it can be considered the best treatment for nephroureterectomy that is one of the most frequent urological procedures. The main indications to MIS ureteronephrectomy in children are congenital or acquired benign conditions such as nonfunctional and/or damaging kidney, renal dysplasia, and destroyed kidneys due to obstructive or refluxing uropathy. Since ever in open urological surgery, the lateral retroperitoneal approach represents the typical way to approach this kind of surgery. Although different surgical approaches can be chosen (i.e., posterior retroperitoneal, lateral retroperitoneal, laparoscopic transperitoneal, and robotic approach), the lateral retroperitoneal approach represents the typical way to perform this kind of surgery, also with minimally invasive techniques. In this article, we illustrate the technique of retroperitoneoscopic nephroureterectomy in infants and children, reporting our experience with this technique in the past 20 years.

Evaluating the differences in the early laparoscopic donor nephrectomy learning curves of a Swiss high volume transplant program and a South African low volume transplant program after knowledge transfer

BackgroundTo describe the retroperitoneoscopic donor nephrectomy learning curve differences between a high volume (training) hospital in Basel, Switzerland, and a low volume (trainee) hospital in Cape Town, South Africa, after knowledge transfer. The South African hospital is resource constraint in hospital and training equipment. Techniques for performing the surgery were near identical.MethodsBoth units maintained prospective databases. Comparisons were made of the first 74 cases in each database: Basel’s series were from 19 January 2001 until 28 June 2004, while the Cape Town Hospital were from 8 April 2008 until 15 July 2008. Four surgeons operated in the Basel group, while only one surgeon operated in the Cape Town group. Variables compared include operating time (first skin incision until kidney was extracted), warm ischaemic time (renal arterial occlusion until cold bench reperfusion), blood loss, graft function, and hospital stay. We also analysed the first and last 25 cases of each series. Subgroup analysis of a single Basel surgeon was conducted.ResultsDonor age (means: Basel vs. Cape Town 54 vs. 33 p < 0.0001) and gender (males vs. females Cape Town 57% male and Basel 31% male) differed widely. The Basel group did more left-sided operations (72% vs. 58%). Operative times, blood loss and donor creatinine did not differ. Warm ischaemic time was significantly shorter in the Basel group (Cape Town mean 204 s Basel mean 130 s P = 0.0023). There was double the number of early graft failures in the South African group (six vs. three)—not related to donor surgery. Both groups showed a decline in operating times, plateauing at 30–34 cases.ConclusionsThere are statistically significant differences in some aspects of the learning curves of the Swiss (training) and South African (trainee) hospitals. These differences are clinically not pronounced, and the knowledge transfer was worth the effort.

Impact of visceral obesity on operative outcomes of laparoscopic nephrectomy: comparison between visceral fat area and body mass index

BackgroundObesity has been considered as a risk factor influencing operative difficulty. It was reported that body mass index (BMI; kg/m2) did not always properly reflect the degree of a patient’s visceral fat. The purpose of this study is to retrospectively investigate the association of operative outcomes and obesity indices including visceral fat area (VFA; cm2) and BMI in retroperitoneoscopic nephrectomy (RN).MethodsWe retrospectively reviewed consecutive 96 RN procedures performed from September 2016 to June 2020. We divided patients into BMI obese group (BMI ≥ 25, n = 25) and BMI normal group (BMI < 25, n = 71), VFA obese group (VFA ≥ 100, n = 54) and VFA normal group (VFA < 100, n = 42). Patient characteristics, operative and postoperative outcomes were compared between the two groups for each index of obesity.ResultsIn two groups divided by BMI, the only specimen weight was significantly greater in the obese group (320 vs. 460 g, p < 0.001), whereas VFA obese group had longer insufflation time (165 vs. 182 min, p = 0.028), greater estimated blood loss (34 vs. 88 ml, p = 0.003) and greater specimen weight (255 vs. 437 g, p < 0.001) than VFA normal group. In a logistic regression analysis, high VFA value was a significant predictor for greater specimen weight and high VFA value and large size of renal tumor were significant predictors for greater blood loss. By contrast, BMI was not a significant predictor. Furthermore, in the case of non-obese patients (BMI < 25), VFA obese group had significantly longer insufflation time, greater estimated blood loss and greater specimen weight than normal group.ConclusionsThe present data suggest that VFA is a more useful parameter than BMI for predicting the operative difficulty associated with obesity, and VFA has a higher use value in non-obese patients (BMI < 25) than in obese patients (BMI ≥ 25).

Management of renal tumors during pregnancy: case reports

BackgroundRenal tumors during pregnancy are rare and the treatment requires evaluation of both the patient and the fetus. No consensus or guidelines has been proposed or verified in this field. We successfully managed three renal tumor cases during pregnancy and reviewed the relative literature.Case presentationIn the first renal cell carcinoma case diagnosed in the 21st week of pregnancy, laparoscopic retroperitoneoscopic partial nephrectomy was performed in the 26th week of pregnancy. In the second renal cell carcinoma case diagnosed in the 3rd week of pregnancy, laparoscopic retroperitoneoscopic radical nephrectomy was carried out after the abortion. In the third angiomyolipoma case who was diagnosed before pregnancy but received no treatment, we performed laparoscopic retroperitoneoscopic partial nephrectomy during the 17th week of pregnancy due to the rapid enlargement of the tumor.ConclusionAlthough no consensus or guidelines for the management of renal tumors in pregnant patients has been proposed or verified, the general rules of kidney tumor management in non-pregnant patients and the guidelines for surgery in pregnancy could be referred to. Renal tumors found in pregnant patients require an individualized treatment regimen involving surgical timing, routes, techniques, and excision ranges, which should be decided by both the patients and the surgical teams.

Native nephrectomy in the management of hypertension in children with kidney disease: a tool to improve blood pressure control.

Hypertension in children with abnormal kidneys often requires multiple antihypertensive agents (complex), or could present with complications (e.g. hypertensive encephalopathy). Our objective in this report is to evaluate blood pressure control following unilateral or bilateral laparoscopic native nephrectomy in children with renal hypertension. Single-centre retrospective review of all children who underwent nephrectomy for management of hypertension over a recent study period (2008-2017) with post-operative follow-up of at least 3years. We describe the association of age, primary kidney disease and blood pressure and its management including time to resolution following unilateral or bilateral nephrectomy. During the 9-year study period, 21 of 215 (9.8%) children underwent nephrectomy for management of hypertension. We included 19 children [6 with unilateral native nephrectomy (UNN) and 13 with bilateral native nephrectomy (BNN)] in this study as they continued with their follow-up at our centre. Out of the 19 children, 15 had laparoscopic retroperitoneoscopic nephrectomies and 4 had laparoscopic transperitoneal nephrectomies. Six children had unilateral nephrectomy and 13 children had bilateral nephrectomies [7 were pre-transplant (haemodialysis-6, peritoneal dialysis-1) and 6 were post-kidney transplant]. Fifteen of 19 children (79%) had complete resolution [5 UNN and 10 BNN] and 3 (16%) partial resolution [1 UNN and 2 BNN]. One patient with BNN was observed to have no change in blood pressure control. Our data demonstrate improved management of hypertension in 95% of the children. Nephrectomy could offer a reasonable treatment option for selected group of complex and complicated renal hypertension.

Retroperitoneoscopic nephrectomy versus open surgery for non-tuberculous pyonephrotic nonfunctioning kidney: a single-center experience.

BackgroundPatients with obstructive pyonephrotic nonfunctioning kidney (OPNK) often require simple nephrectomy for long-term severe clinical symptoms. We aimed to analyze the outcomes of retroperitoneal laparoscopy versus open surgery for OPNK.MethodsThe study included clinical data of 69 patients with non-tuberculous OPNK from January 2015 to June 2019 in a single center. The patients were divided into laparoscopic group (LS, N=33) and open surgery group (OS, N=36). Those whose pathological findings were xanthogranulomatous inflammation or tuberculous granuloma were excluded. Statistical analysis compared the two groups in terms of basic demographic characteristics, preoperative laboratory examination results, and intraoperative and postoperative observation indicators.ResultsThe results showed that non-tuberculous OPNK were more common in women (female/male =4:1). Compared with the LS group, patients in the OS group had higher white blood cells (WBC; P=0.010) and neutrophils (P=0.005) counts before surgery. The main clinical symptoms were low back pain, pyuria, and fever; among them, low back pain combined with pyuria was in the majority. More intraoperative hypotension events were observed in the OS group (P=0.007). Notably, subgroup analysis showed larger stone size happened in the OS group (OR 3.538, 95% CI, 1.337, 9.208). No statistical difference was found in the duration of surgery between the two groups while the length of postoperative hospitalization and retroperitoneal drainage, and postoperative blood transfusion rate increased significantly in the OS group. Postoperative use of non-steroidal anti-inflammatory drugs was more common in the LS group, while opioid analgesics were in the OS group (P=0.0006). There was no statistical difference in other complications.ConclusionsIn conclusion, considering the advantages of LS in terms of postoperative blood transfusion, surgical drainage and length of hospital stay, we recommend it for non-tubercular OPNK when the stone load of pyonephrosis side was less than 280 mm2 and the preoperative WBC and neutrophil count were within the normal range.

Retroperitoneoscopic nephrectomy: current status

The classic retroperitoneal open surgical access to the kidney has been duplicated while performing laparoscopy but is less common than transperitoneal laparoscopy. We reviewed minimally invasive retroperitoneoscopic nephrectomy as a part of the international consultation on urological diseases and European Association of Urology international consultation on minimally invasive surgery in urology. A Pubmed/Medline search was performed to identify studies assessing the feasibility, safety and efficacy of laparoscopic and robotic retroperitoneoscopic nephrectomy. The articles were reviewed to assess outcomes after simple, radical and donor nephrectomy and comparative trials between retroperitoneoscopic versus the open and transperitoneal route were evaluated. Retroperitoneoscopic nephrectomy is feasible for most cases of benign non-functioning kidneys. Retroperitoneoscopic radical nephrectomy is also feasible for most tumours and may be better suited for posteriorly located tumours. Both retroperitoneoscopic and transperitoneal nephrectomy have similar outcomes but the operative time may be shorter for the former. The data are insufficient for robotic retroperitoneoscopic nephrectomy probably because of limited space and lack of benefit of a robot in ablative surgeries. Level of evidence: 3a

P0039IS A NEPHRECTOMY POLYCYSTIC KIDNEY DISEASE NECESSARY FOR PATIENTS WITH END-STAGE CHRONIC KIDNEY DISEASE?

Abstract Background and Aims In the structure of end-stage CKD polycystic kidney disease is about 8-10 %. These patients often required preparation for transplantation. In addition, enlarged kidneys are reducing the volume of the abdominal cavity, negative impact on the peritoneal dialysis (PD). Method In 2005-2019 41 nephrectomies were performed in patients with end-stage CKD with polycystic kidney disease: 11 patients have undergone open nephrectomy, 13 patients laparoscopic nephrectomy and 17 retroperitoneoscopic nephrectomy. We analyzed postoperative period and complications, method of treatment end-stage CKD selected in future. In particular, we evaluated the effectiveness of peritoneal dialysis depending on the operating access. Results Complications: intraoperative bleeding was in 3 cases, damage of the spleen was in one. The significantly lower blood loss was in the group of operations performed endoscopic access. Subsequently, 16 patients were treated with hemodialysis (HD), 25 patients PD. The effectiveness of PD was estimated by 3 months and 1 year after start treatment by kt/v. In the group of patients with open nephrectomy, the effectiveness on average was 1.61 and 1.44 respectively. Patients underwent laparoscopic nephrectomy the efficiency is in average of 1.72, and 1.60, retroperitoneoscopic nephrectomy 1.88, 1.72 respectively. The conversion method of PD-treatment to the HD within 6 months after surgery was required in 5 patients (open nephrectomy technique), 2 patients (laparoscopic technique), no one patient (retroperitoneoscopic technique) was not required for the conversion PD to HD. Conclusion Our experience of nephrectomies in patient with end-stage CKD indicate the safety and effectivity of the endoscopic technique and its applicability to patients on PD. Retroperitoneoscopic access has less impact on the effective area of the peritoneum, which is reflected in the subsequent course of PD.

Use of endoscopic tissue morcellator in removing retroperitoneal fat in retroperitoneoscopic radical nephrectomy

BackgroundEvaluate the safety and effectiveness of using an endoscopic tissue morcellator (ETM) to remove the retroperitoneal fat during retroperitoneoscopic radical nephrectomy (RRN).MethodsThe use of ETM in the removal of retroperitoneal fat was retrospectively analyzed in patients who underwent RRN for localized renal cancer in our hospital from January 2010 to January 2018. We accrued the appropriate patients and divided them into two groups. The first group included patients of RRN where ETM was used to remove the retroperitoneal fat, while the second group was comprised of patients of RRN where ETM was not performed, which served as the control group. Each group was further divided into two subgroups, including obese patients (BMI ≥ 28) and patients suffering from high-volume renal cancer (Stage T2a). The differences between the two groups as well as their subgroups were analyzed and statistically compared.ResultsAll 222 nephrectomies were completed under retroperitoneoscopy, ETM was used in 105 of these 222 patients. Among them, 31 cases were of obese patients, and 26 cases were of high-volume renal cancer patients. The other 117 patients had undergone RRN without the use of ETM. Among them, 36 cases were of obese patients, and 28 cases were of high-volume renal cancer patients. The differences in age, BMI, tumor position, and tumor size between the two groups were not statistically significant, P > 0.05. Both the surgical time and the blood loss for the ETM group were significantly lower than the control group, p < 0.05. In the subgroup analysis, the obese patients and patients with high tumor volume also showed a significantly lower surgical time and less blood loss, p < 0.05. The postoperative hospitalization time, the total survival rate, and the disease-free survival rate were not statistically significant, p > 0.05.ConclusionsThe use of ETM in removing the retroperitoneal fat during the RRN can potentially reduce the surgical time and lessen the blood loss. This technique is especially advantageous for obese and large-volume tumor patients.

Comparative Analysis of Long-Term Postoperative Complications of Traditional, Laparoscopic and Retroperitoneoscopic Nephrectomy

Comparative Analysis of Long-Term Postoperative Complications of Traditional, Laparoscopic and Retroperitoneoscopic Nephrectomy

The manufacture and application of novel evaluating tool for renal vascular anatomy: the system of individualized reno-vasculature evaluation for nephrectomy

Objective To explore the clinical feasibility and effectiveness of novel preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy for retroperitoneoscopic radical nephrectomy (RLRN). Methods Two-hundred and fifty one consecutive patients who underwent RLRN for renal tumours from September 2016 to March 2018 were enrolled prospectively, including 154 males (61.4%) and 97 females (38.6%), aged 26 to 84 years with the mean age of 58.7 and mean BMI of 25.8 kg/m2. The tumors were all isolated with the mean size of 5.4 cm. According to presence or absence of vascular correlation events (VCE) and nephrectomy times under endoscope (NTE), all the cases were divided into two groups: the common group (VCE, NTE <60 min) and the difficult group (no VCE, NTE ≥60 min). With the help of preoperative three-dimensional reconstruction, the specific and crucial arteriovenous anatomical features were recorded, which consist of side, count, spatial configuration and density of the vessel to be processed. After univariable analysis, multivariable analysis with logistic regression was performed for the selected risk factors. Individualized reno-vasculature evaluation for nephrectomy were established, when the value of risk factors were assigned separately according to its correlation and clinical practice. Results There was no statistical significance between common group and difficult group in the aspects of gender, age, BMI, maximum diameter of the tumor, R. E.N.A.L. score and PADUA score. There were statistical significance between common group and difficult group in the aspects of N (number of total vessels), D (vascular anomalies density), C (3D conformation), S (sides) of pending renal vessels (χ2=125.700, 102.014, 97.090, 12.603, P 0.05). SIREN was preliminarily established as a preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy. Of the 5 components of SIREN, N, D were scored on 1 to 3 points, C was scored on 0 to 3 points, E was scored on 0 to 1 point, and S was not scored but showed in terms of L or R. All of these constitute the assessment content with a full score of 10 points except S suffixed by L or R instead of scores. There was a statistically significant difference during low (2-3 points), middle (4-6 points), and high (7-10 points) groups (χ2=126.927, P<0.05) according to the comparisons between low and middle, low and high, as well as middle and high (χ2=90.997, 7.195, 91.679, P<0.05). Conclusions In virtue of the renal vascular scoring system named after SIREN by 3d reconstructing, the spatial structure information of the renal vascular system can be obtained accurately and expressed directly before operation, the difficulty of vascular treatment can be predicted, the preoperative planning can be optimized, and the accurate quantitative evaluation of renal vascular anatomical structure can be achieved to further improve the surgical safety and efficiency. Key words: Laparoscope; Nephrectomy; Influence factor; Renal vascular; Scoring standard

Application of totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis in upper urinary tract urothelial carcinomas treatment

To evaluate the feasibility and effectiveness of the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis in the treatment of upper urinary tract urothelial carcinoma (UTUC), and to review the experience of renal autotransplantation for UTUC treatment. One case of applying the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis to the UTUC treatment was reported, and related literature was reviewed. The patient was a sixty-four-year old man who received right radical nephroureterectomy for right ureteral carcinoma 1 year before and diagnosed as left ureteral carcinoma(G2, high grade) this time. In order to preserve his renal function and avoid the shortness of common kidney-sparing surgery, a totally extraperitoneal procedure, including retroperitoneoscopic nephrectomy, ureterectomy, renal autotransplantation and Boari flap-pelvis anastomosis, was performed to the patient. The operation was completed successfully without perioperative complications. The renal function recovered to preoperative level within 1 week. No deterioration of renal function during the follow-up and no tumor recurrence was observed under cystoscopy at the 3-month postoperative consult. The totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis is a feasible and effective treatment for UTUC. The innovative procedure has several advantages compared to the former ones. The extraperitoneal procedure results in significantly less pain, shorter hospital stay, decreased overall time to recovery and lower bowel complications risk without warm ischemia time extension. Meanwhile, the Boari flap-pelvis anastomosis simplifies the follow -up protocols and creates an easy route for cystoscopy and topical therapy. From the systematic clinical analysis, as well as the related literature review, it's been concluded that the renal autotransplantation can be a reasonable option for the patients who have UTUC in solitary kidney or have bilateral UTUC. This type of treatment possesses advantages of preservation of renal function and total resection of malignant lesions. But long-term data and large cohort study on renal function or tumor recurrence are still absent which will be necessary to confirm the advantages of this approach.

Initial Experience of Retroperitoneoscopic Surgery in Benign Renal Diseases

Background: To review our early experience to determine the feasibility, efficacy and clinical outcomes of retroperitoneoscopic surgery in benign renal diseases.Methods: This is a prospective observational study carried out between December 2014 to March 2018. Among 14 patients enrolled in the study, 9 cases of nonfunctioning kidney underwent retroperitoneoscopic simple nephrectony, 4 cases of benign renal cortical cysts underwent decortication of cysts and one case of pelviureteric junction obstruction underwent Anderson Hynes pyeloplasty. Results: Retroperitoneoscopic nephrectomy, renal cyst decortication and A-H pyeloplasty were performed in 13 patients successfully. The procedure in one patient of RP nephrectomy converted to open surgery due to dense perinephric and hilar adhesions. Which resulted to failure to progress. The mean operative time of RP nephrectomy, decortications and pyeloplasty were 206.4 (150-248), 67.5 (60-80) and 275 minutes, average blood loss was 96.7 (50-120), 27.5 (20-30) and 70 ml, and the mean hospital stay were 3.5 (3-4), 2 (2-2) and 4 days respectively. The perioperative period was uneventful.Conclusions: Retroperitoneoscopic surgery is feasible and safe in benign renal diseases. Because of reduced post operative pain and less chances of bowel injury, retroperitoneoscopic surgery is gaining more popularity.Keywords: Nonfunctioning kidney; pyeloplasty; renal cyst; retroperitoneoscopic surgery.

Comparative analysis of short-term results of retroperitoneoscopic and laparoscopic radical nephrectomy for large kidney tumors

The study objective is to perform comparative analysis of short-term results of retroperitoneoscopic and laparoscopic radical nephrectomy for large kidney tumors. Materials and methods . The study is based on the results of examination and treatment of 108 patients with stage Т 1—3 а renal cell carcinoma. Results . For retroperitoneoscopic radical nephrectomy, significant decrease in operative time, ligation and transection of the renal hilum, lower carbon dioxide expenditure, less intense pain sensations on day 1 after the surgery, lower analgesics expenditure, and hospitalization time. Conclusion . The results show the advantages of retroperitoneoscopic radical nephrectomy compared to laparoscopic nephrectomy.

Letter to the Editor RE: Hirose et al., Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopy Living Donor Nephrectomy (From: Hirose T, Hotta K, Iwami D, et al. J Endourol 2018;32:1120-1124; DOI: 10.1089/end.2018.0669).

Letter to the Editor RE: Hirose et al., Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopy Living Donor Nephrectomy (From: Hirose T, Hotta K, Iwami D, et al. J Endourol 2018;32:1120-1124; DOI: 10.1089/end.2018.0669).

Comparative analysis of intra- and postoperative complications of retroperitoneoscopic and laparoscopic nephrectomy for large tumors

The objective is to perform comparative analysis of intra- and postoperative complications of retroperitoneoscopic radical nephrectomy (RRN) and laparoscopic radical nephrectomy (LRN) for large tumors. Materials and methods . The study includes examination and treatment data for 108 patients with stage T1—3a renal cell carcinoma. Results and conclusion . A number of advantages of RRN compared to LRN were demonstrated associated with shorter surgery duration with fast processing of the renal pedicle, lower blood loss, lower use of analgesics in the postoperative period, shorter duration of hospitalization, and quick recovery after the surgery. The rate of intra- and postoperative complications for RRN was 19.2 and 17.3 %, for LRN — 33.9 and 37.5 %, respectively. Complications associated with abdominal organs were absent for RRN. After LRN, the rate of serious complications was significantly higher than after RRN.

Review of the article “Comparative analysis of intra- and postoperative complications of retroperitoneoscopic and laparoscopic nephrectomy for large tumors”

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