Safety Of Laparoscopic Nephrectomy Research Articles

Comprehensive Surgical Audit of Live-Related Donor Nephrectomy: Procedural Parameters, Demographics, Health Assessments, Complications, and Postoperative Outcomes.

End-stage renal disease (ESRD) rates are on the rise globally, including in India. However, the affordability of dialysis treatment remains a significant challenge for many, with costs varying across different regions. Although cost-effective, kidney transplantation faces challenges like a surgeon shortage, lack of infrastructure, and lack of logistic support. The study examines Indian laparoscopic nephrectomy outcomes and their benefits for donor recovery. It covers kidney donor procedural details, demographics, preoperative health evaluations, complications, and one-month follow-up. Ethical approval was obtained, and the study involved 102 cases at the Indira Gandhi Institute of Medical Science, Patna, Bihar, India, from 2019 to 2023. Detailed preoperative assessments, postoperative complications, and one-month follow-up analyses were conducted. Statistical analysis employed SPSS version 17 (IBM Corp., Armonk, NY). The results revealed an average surgery time of 152.3 min, blood loss of 205 ± 42 ml, and a hospital stay of 4.6 ± 2.2 days. The study found a female predominance (80.39%), with a mean donor age of 35.9 ± 5.2 years. Preoperative assessments showed robust patient health, with glomerular filtration rate (GFR) exceeding the expected threshold and normal urea levels, creatinine, electrolytes, liver enzymes, bilirubin, albumin, and total protein. Post-nephrectomy complications were reported, with females experiencing more difficulties than males. This study underscores the efficiency and safety of laparoscopic nephrectomy in the Indian context, providing valuable insights into donor demographics, preoperative health assessments, complications, and postoperative outcomes. The findings contribute to understanding laparoscopic nephrectomy outcomes and associated risk factors despite certain limitations.

Feasibility and safety of laparoscopic nephrectomy in emphysematous pyelonephritic kidneys

Background: Emphysematous pyelonephritis (EPN) is a serious suppurative infection of renal and extrarenal tissues. Most of them end up in nephrectomy, either in an emergency setting or delayed, which is increasingly favored. Laparoscopic nephrectomy is difficult in the post-EPN state due to dense adhesion around the kidney. Aims and Objectives: In this study, we want to check the feasibility of laparoscopic nephrectomy in EPN kidneys. To the best of our knowledge, our series is the single largest series as of today with 10 cases of laparoscopic nephrectomies in EPN kidneys. Materials and Methods: All patients of EPN who underwent laparoscopic nephrectomy at Institute of Kidney Diseases and Research Centre, Ahmedabad, between December 2017 and October 2019 were taken as study subjects and retrospectively reviewed. Patients in whom conservative management was successful were excluded from the study. All patients were diverted initially, either ultrasound/computed tomography-guided percutaneous nephrostomy (PCN) insertion or double J stenting, with or without PCN along with antibiotics and supportive therapy. Delayed transperitoneal laparoscopic nephrectomies were performed for poorly functioning EPN kidneys in follow-up renal scans. Results: A total of 10 patients underwent nephrectomy in this period. The male-to-female ratio was 3:7. As per Huang and Tseng’s EPN classification, one patient had Class 2, four patients had Class 3a, and five patients had Class 3b EPN disease. Mean operative time was 192 min and mean blood loss was 206 ml. Two cases had intraoperative complications managed laparoscopically. No conversion to open nephrectomy or mortality was seen. The drain was placed for a mean period of 3.1 days. The mean hospital stay was 4.8 days. Conclusion: Laparoscopy is safe and feasible for nephrectomy in EPN kidneys. Experience with laparoscopy and operating on pyelonephritis cases is important to reduce complications and extend the advantages of laparoscopy in these groups of patients. An increase in class does not increase the degree of difficulty during laparoscopy.

Laparoscopic radical nephrectomy with inferior vena cava level I–III thrombectomy: experience of one center and literature review

Objective. Radical nephrectomy with thrombectomy of the inferior vena cava is the preferred treatment for renal cell carcinoma with an tumor thrombosis. We describe our experience and presentreview of the literature evaluating the feasibility and safety of laparoscopic nephrectomy with inferior vena cava thrombectomy.Materials and methods. The study included 37 patients who underwent laparoscopic radical nephrectomy with level I–III thrombectomy for renal cell carcinoma in our institution from 2018 to 2021. We analyzed the clinical, radiographic, intraoperative, pathological and postoperative parameters of the patients. The literature was reviewed by the Medline search engine, PubMed, with a review of publications on laparoscopic radical nephrectomy with inferior vena cava levelI–IIIthrombectomy.Results. The mean operation time was 275 ± 60.1 min, the median blood loss was 450 ± 81.6 ml (≥50 % of the circulating blood volume – 32.4 %). Intraoperative complications were observed during 10 (27.0 %) operations. Postoperative complications developed in 29.7 % of patients and reached gradesIII–IV according to the Clavien–Dindo scale on 13.0 % ill. All patients are activated according to the fast track rehabilitation program. The average hospital stay was 5 days. A literature review identified clinical cases and small series demonstrating the technical feasibility and safety of laparoscopic radical nephrectomy with thrombectomy in selected patients.Conclusion. Laparoscopic radical nephrectomy with thrombectomy is a technically feasible approach in carefully selected patients with level I–III tumor thrombosis. Optimal patient selection, extensive experience in laparoscopy and specialized centers are essential for the safe use of thistechnique.

Laparoscopic nephrectomy: Moroccan experience of 68 cases

BackgroundThe aim of this study was to analyze the feasibility and the safety of laparoscopic nephrectomy in the treatment of pathologies of the upper urinary tract through the experience of the Urology B department.MethodsWe have retrospectively and monocentrally selected patients who underwent laparoscopic nephrectomy from January 2017 to December 2019. The collection was carried out on archived files, based on demographic, clinical and perioperative data. The primary endpoint was the occurrence of complications and secondarily the length of the operation and the length of hospital stay. The statistical analysis was carried out using the SPSS software.ResultsA total of 68 patients were included in our series. The average age of our patients was 57.8 years. There was a slight female predominance: 39 female patients (57.4%) for 29 male patients (42.6%). Indications for nephrectomy were dominated by renal tumor (33.82%) followed by lithiasis (16.17%) and non-functioning kidney (16.17%) at the same rank. During the study period, 31 (45.6%) simple nephrectomy, 26 (38.2%) total nephrectomy, 1 (1.5%) partial nephrectomy and 10 (14.7%) nephroureterectomy were performed in our department. In our series, the average operating time was 180 min. Estimated blood loss averaged 321.8 ml with extremes of a few milliliter to 1100 ml. Intraoperative complications were reported in 10 (14.7%) patients; conversion was necessary in 6 cases (8.82%). The postoperative follow-up was straightforward in 53 (77.94%) patients with an average hospital stay of 3.6 days. The rate of postoperative complications according to Clavien–Dindo was 22.1%. Histological examination of the nephrectomies carried out in our department revealed mainly chronic non-specific pyelonephritis in 24 (35.3%) patients, followed by renal cell carcinoma in 23 (33.82%) patients and urothelial carcinoma in 9 (13.2%) patients.ConclusionLaparoscopic nephrectomy appears to be an efficient and reliable technique. This technique has led to a significant improvement in operative morbidity, mainly represented by the length of hospital stay, operating time and blood loss.

Пути улучшения результатов лечения пациентов с терминальной стадией хронической почечной недостаточности в исходе урологических заболеваний и активным течением пиелонефрита

Introduction. Patients in the outcome of urological diseases after the beginning of treatment with hemodialysis in the presence of permanent drainage in the kidneys, or with recurrent pyelonephritis have high risks of urosepsis and death. In order to improve the results of diagnosis and treatment of this category of patients, we analyzed our own results. Materials and methods. The study included 58 patients with end-stage chronic renal failure (ESRD) who were treated with hemodialysis and had a nephrectomy for active pyelonephritis in the period from 2013 to 2020. Results. The most informative method in the diagnosis of pyelonephritis was magnetic resonance imaging using diffuse-weighted image protocols (MRI-DWI), the diagnostic efficiency was 94%. There were no differences in the frequency of intraoperative complications in laparoscopic and open nephrectomy. The mortality rate after nephrectomy was 25.9% (n=15). With a preoperative C-reactive protein (CRP) level of more than 95 mg/l (p=0.011) and a Charlson comorbidity index of more than 5 (p=0.003), a high probability of death was predicted. Long-term (more than 14 days) antibacterial preoperative therapy was significantly associated with sepsis before surgery, postoperative antibiotic-associated colitis, and infectious-inflammatory complications from the postoperative wound. Discussion. Our work, as well as many other publications, demonstrates a high incidence of septic complications in patients with ESRD. Patients with permanent drainage in the upper urinary tract are most at risk. this study convincingly showed that the results of nephrectomy are significantly worse in the presence of a systemic inflammatory reaction (SIRS), and therefore it is advisable to perform a nephrectomy before the development of SIRS. Our opinion on the possibility and safety of laparoscopic nephrectomy in chronic pyelonephritis in patients with ESRD who have undergone repeated renal interventions is consistent with a number of other studies in recent years. Conclusion. Diagnosis of pyelonephritis in patients with ESRD is advisable to start with MRI-DWI. The results of nephrectomy are better in the absence of a systemic inflammatory response. It is necessary to minimize antibacterial therapy before surgery. Laparoscopic nephrectomy is a safe procedure for inflammatory kidney diseases.

Laparoscopic nephrectomy simplified - A "two-window technique" for safer approach to hilum for a novice.

Though the overall safety of laparoscopic nephrectomy (simple or radical) is well established, for a novice it remains a challenge. The classical description of laparoscopic nephrectomy entails dissection either from caudal to cephalad side or vice versa. Herein we describe our “two window technique” for managing renal hilum during laparoscopic (simple/radical) nephrectomy. Our main intention in description of this technique is to reduce the level of apprehension for a novice urologist for performing laparoscopic nephrectomy. After colon mobilization, sequential lower and upper windows are created around the hilum following which hilar vessels are dissected circumferentially when the hilum is at a stretch by traction from either of the window. There are multiple potential advantages of this method which includes easier and safer dissection especially for novice in this field by giving a safety window of application of vascular clamp in cases of vascular bleeds. Intrahilar dissection in stretched condition becomes safer with vision from all around 360° for safe application of Hem-o-lok® clips. Due to the widely exposed field, injuries to adrenal vein and lumbar veins would be minimized and the chances of missed accessory vessel would be minimized. En mass hilar control with vascular clamp in cases of partial nephrectomy is possible with same approach as well as the en block stapling is feasible in cases of nephrectomy. This needs a validation across multiple centers with comparative studies before considering it as a standard of practice. We sincerely believe that this is safe and easily reproducible by a novice.

Feasibility and safety of laparoscopic nephrectomy in uremic patients with end-stage renal disease.

The purpose of this study was to analyse the feasibility and safety of laparoscopic radical nephrectomy (LRN) vs. open radical nephrectomy (ORN), in terms of perioperative and postoperative outcomes, in uremic patients. Between September 2007 and December 2013, 19 patients with end-stage renal disease (ESRD), who underwent LRN or ORN for chronic pyelonephritis, renal calculi, hydronephrosis, renal tumors, complicated cyst, or associated polycystic kidney, were retrospectively analysed. All patients with complete preoperative clinical and intraoperative parameters, including age at surgery, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, surgical technique, operation time, complications, were available for further analyses. The 30-day complication rate in both groups was retrospectively review and graded according to the modified Clavien System in five grades. Overall, nine (47.3%) vs. 10 (52.7%) patients underwent LRN vs. ORN, respectively. The mean ASA score (2.7 ± 0.8 vs. 2.9 ± 0.7) did not show statistically significant differences in both groups (p = 0.632). None of the patients in G1 was converted to open surgery for intraoperative complications or CO2 retention. The estimated blood loss was 223 ± 155 mL in G1 and 455 ± 134 mL in G2 (p<0.005). Both groups were comparable with regard to mean operation time. The mean hospital stay was 5.95 ± 1.85 days in G1 and 8.10 ± 1.67 days in G2 (p<0.001). The present study revealed that laparoscopic surgery in uremic patients might be performed safely under the expertise of an experienced laparoscopic team. This surgical technique is a minimally invasive treatment, reduces blood loss, shortens postoperative hospital stay, minimizes wound pain, and encourages an earlier return to normal activity.

Laparoscopic Nephrectomy versus Open Nephrectomy for Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis.

ObjectiveTo compare efficacy and safety of laparoscopicnephrectomy (LN) versusopen nephrectomy (ON) in the management of autosomal dominant polycystic kidney disease (ADPKD), we conducted a systematic review and meta-analysis.MethodsA systematic search of the electronic databases PubMed, Scopus, and the Cochrane Library was performed up to October 2014.This systematic review was performed based on observational comparative studies that assessed the two techniques. The weighted mean difference (WMD) and risk ratio (RR), with their corresponding 95% confidence interval (CI), were calculated to compare continuous and dichotomous variables, respectively.ResultsSeven studies were identified, including 195 cases (118 LN / 77 ON). Although LN was associated with longer operative time (WMD 30.236, 95%CI 14.541 −45.932, P<0.001) and the specimen might not have been resected as heavy as the ON group (WMD -986.516, 95%CI -1883.24–-89.795, P = 0.031), patients in this group might benefit from a shorter length of hospital stay (WMD -3.576, 95%CI 4.976–-2.176, P <0.001), less estimated blood loss (WMD -180.245, 95%CI -317.939–-42.556, P = 0.010), and lower need of transfusion (RR 0.345, 95%CI 0.183–0.650, P = 0.001). The LN group also had less overall complications (RR 0.545, 95%CI 0.329–0.903, P = 0.018). The need of narcotic analgesics between the two groups might have no significant difference (WMD -54.66, 95%CI -129.76–20.44, P = 0.154).ConclusionLN for giant symptomatic ADPKD was feasible, safe and efficacious. Morbidity was significantly reduced compared with the open approach. For an experienced laparoscopist, LN might be a better alternative.

The efficacy and safety of laparoscopic nephrectomy in patients with three or more comorbidities

Laparoscopic surgery for kidney treatment is a common procedure. However, the efficacy of this procedure in patients with several comorbidities has not been well investigated. We conducted a retrospective comparison of results of laparoscopic surgery between patients with several comorbidities and patients with no comorbidity to access the efficacy and safety of this procedure. The subjects were 20 patients with three or more comorbidities (group A) and 46 patients with less than three comorbidities (group B). These 66 patients were 48 men and 18 women with a mean age of 62.3 years (age range, 24-83 years). The data from these two groups were compared for American Society of Anesthesiology (ASA) physical status score, previous surgical history, duration of surgery, estimated blood loss, tumor size, complications during and after surgery, conversion rates, time to oral intake, and length of hospital stay. The initial ASA score and age were significantly higher for the patients with comorbidities (P < 0.0001, P = 0.0008, respectively). All other variables before, during, and after surgery were similar for both laparoscopic groups. However, the incidence of atelectasis of laparoscopy was higher than that of open surgery. Laparoscopic nephrectomy for patients with comorbidities is safe and minimally invasive. Further investigation to prevent atelectasis is necessary.

Open versus laparoscopic donor nephrectomy in live related renal transplantation

Background This analysis sought to evaluate the efficiency and safety of laparoscopic nephrectomy (LDN) for the donor, the recipient, and the graft. LDN seems to have advantages over the open donor nephrectomy (ODN) in length of hospital stay, postoperative comfort, and pain control. Methods The results of 40 patients who underwent LDN between October 2000 and September 2003 were compared to those of 40 ODN patients just preceding the LDN patients. Eight laparoscopy patients required conversion to an open procedure due to bleeding (4; two major and two minor), technical problems with the instrument ( n = 1) and difficulty in the dissection ( n = 3). Results The demographic data, percentages of right and left nephrectomy, number of vessels, rates of acute rejection episodes, as well as the rates of urologic and vascular complications were similar between the two groups. The time of hospital stay was shorter, and the duration of the operation and of the warm ischemia time were significantly longer for the LDN group. The postoperative decline in serum creatinine levels were similar for the two groups. Graft survival rates were 91.7% at both the first and third years in the LDN group; 92.5% and 87.0% for the ODN group, a difference that was not statistically significant. Conclusion LDN is as efficient and safe as ODN for donors, recipients, and grafts.

Evaluation of the efficacy and safety of laparoscopic nephrectomy.

To evaluate the efficacy and safety of laparoscopic nephrectomy. From June 1994 to November 1999, 10 patients underwent laparoscopic nephrectomy at Osaka University Medical Hospital and Osaka Rosai Hospital. Laparoscopic nephrectomy was performed either via transperitoneal or retroperitoneal approach under general anesthesia. These 10 cases were reviewed in respect of primary disease of the kidney, operative time, complications and postoperative convalescence. Of the 10 patients, five were preoperatively diagnosed as having a non-functioning kidney with hydronephrosis, two patients were diagnosed as having an atrophic kidney, two had renal cell carcinoma and one had renal pelvic tumor. The average operative time was 374 min (range 270-675 min). The mean blood loss was 330 mL (range 60-800 mL). One patient required transfusion due to postoperative oozing. The average hospital stay after operation was 7 days. No major postoperative complications were observed. Laparoscopic nephrectomy is an option in surgically managing renal disorders, including malignancies, although it has a longer operative time compared to conventional open surgery.

HAND ASSISTED LAPAROSCOPIC NEPHRECTOMY: COMPARISON TO STANDARD LAPAROSCOPIC NEPHRECTOMY

Purpose We report our initial experience with hand assisted laparoscopic nephrectomy, and compare it to our results of standard laparoscopic nephrectomy. Materials and Methods The results of 21 hand assisted and standard laparoscopic nephrectomies (15 simple and 4 radical nephrectomies, and 2 nephroureterectomies) were reviewed. Hand assisted laparoscopic nephrectomy was performed with a hand placed intra-abdominally using the Pneumo Sleeve, * * Dexterity, Inc., Blue Bell, Pennsylvania. in addition to standard laparoscopic instruments manipulated through laparoscopic ports. Standard laparoscopic nephrectomy was performed using laparoscopic instruments alone. Perioperative data were recorded and questionnaires, including visual analog pain scales, were administered prospectively to 17 of 21 cases. Results The average operative time for 13 hand assisted laparoscopic nephrectomies was 240 minutes, which was significantly less than the 325-minute average for 8 standard laparoscopic nephrectomies (p = 0.04). Major complications tended to be more frequent in the standard group (38 versus 8%, p = 0.10). Hospital stay, return to normal activity and corrected 2-week abdominal/flank pain score in the hand assisted group (3.1 days, 14 days and 0.8, respectively) were not significantly different from the standard group (3.0 days, 10 days and 0.2, respectively). Conclusions Compared to standard laparoscopic techniques, hand assistance appears to facilitate the operative speed and safety of laparoscopic nephrectomy without sacrificing the benefits of minimally invasive surgery. Hand assistance may make laparoscopic nephrectomy more appealing to urologists without advanced laparoscopic experience, may facilitate the laparoscopic management of demanding pathological conditions and is particularly useful when intact specimens are required. Hand assistance, by improving manipulative ability and tactile sense, is helpful for select cases of laparoscopic nephrectomy.