Korean J Urol.  2008 Feb;49(2):107-112.

Retroperitoneal Laparoscopic Nephrectomy for Inflammatory Renal Diseases

• Cho HK
• Kim DS
• Ryu DS
• Oh TH
• Jeon YS

Abstract

PURPOSE: Retroperitoneal laparoscopic nephrectomy for inflammatory renal conditions remains technically challenging, but can prevent intraperitoneal contamination by inflammatory or pathologic materials and decrease the risk of visceral injury or peritoneal morbidity. We evaluated retroperitoneal laparoscopic nephrectomy in terms of feasibility, safety, and efficacy in inflammatory renal disease.
MATERIALS AND METHODS
Between March 2003 and June 2006, retroperitoneal laparoscopic nephrectomy was performed in 39 patients with benign renal disease. Of the 39 patients, 18(group 1) had inflammatory renal diseases with perinephric stranding on CT, which was confirmed as an adhesion during surgery. The remaining 21 patients(group 2) had nonfunctioning kidneys without significant inflammation. Intraoperative and postoperative clinical parameters were analyzed and compared between the 2 groups.
RESULTS
Retroperitoneal laparoscopic nephrectomy was successful in all 39 patients without conversion to open surgery. Group 1 included tuberculous pyelonephritic kidney(n=11), xanthogranulomatous pyelonephritis (n=3), pyonephrosis(n=2) and renal abscess(n=2). Group 2 included chronic pyelonephritis(n=12), ureteropelvic junction obstruction(UPJ) stricture(n=6), and cystic disease(n=3). The mean operating time and the mean estimated blood loss were significantly different between the 2 groups(p<0.001). The mean time to oral intake and ambulation, and the mean duration of hospitalization were not different between the 2 groups. There were 1 major and 2 minor complications in group 1 and 2 minor complications in group 2.
CONCLUSIONS
Retroperitoneal laparoscopic nephrectomy is a feasible and safe treatment modality in inflammatory renal diseases as well as other benign renal diseases.

Keyword

Laparoscopy; Nephrectomy; Inflammatory renal disease

MeSH Terms

Conversion to Open Surgery
Hospitalization
Humans
Inflammation
Kidney
Laparoscopy
Nephrectomy
Pyelonephritis, Xanthogranulomatous
Walking

Figure

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  Fig. 1. (A) Preoperative CT scan shows right hydronephrosis and perinephric stranding (arrow). (B) Intraoperative finding shows perinephric fibrosis (arrow).

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  Fig. 2. Trocar position. PAL: posterior axillary line, MAL: mid axillary line, AAL: anterior axillary line.

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