Laparoscopic simple nephrectomy after previous ipsilateral open versus percutaneous renal surgery.

BACKGROUND AND OBJECTIVES: Fibrosis after previous open or percutaneous renal surgery may interfere with ipsilateral laparoscopic nephrectomy. We prospectively compared the outcome of laparoscopic nephrectomy in patients with previous open renal surgery or percutaneous nephrolithotomy. PATIENTS AND METHODS: During the study period, 38 patients with previous ipsilateral open renal surgery (n 22) or percutaneous nephrolithotomy (n 16) who underwent transperitoneal laparoscopic nephrectomy were evaluated. All patients had symptomatic nonfunctioning small or hydronephrotic kidneys. RESULTS: Mean age was 57.6 y (range, 15 to 77). Both groups were age and sex matched. Two procedures (both in patients with previous open renal surgery) were converted to open surgery because of difficult pedicle dissection. Mean operative time was nonsignificantly longer in group 1 (111 versus 97 min; P .22). Intraoperative complications consisted of symptomatic capnothorax and diaphragmatic rupture in 1 case per group, managed successfully by inserting a chest tube or laparoscopic repair. Intraoperative blood loss and mean postoperative hematocrit drop were similar in the 2 groups. No significant differences were found between groups in postoperative variables, including time to oral intake, hospital stay, and time to ambulation. CONCLUSION: Transperitoneal laparoscopic nephrectomy in patients with a history of ipsilateral open or percutaneous renal surgery is feasible in a timely manner. Given adequate laparoscopic experience, similar perioperative outcomes can be achieved in both groups. When laparoscopic nephrectomy is used, the precautions that need to be considered are similar for patients with previous percutaneous nephrolithotomy and those with previous open flank surgery.

The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: a comparative analysis of clinical efficacy and functional outcome.

The objective of this study was to analyze the outcome of percutaneous nephrolithotomy (PCNL), laparoscopic and open anatrophic nephrolithotomy (AN) for management of patients with large staghorn renal stones. We analyzed the peri-operative parameters, overall treatment costs and changes in the function of the affected kidney on technetium-99 dimercaptosuccinic acid renal scintigraphy, done before the operation and before the final follow-up visit, in 45 adults who underwent PCNL (n = 16) versus laparoscopic (n = 15) versus open (n = 14) AN for large staghorn renal stones. All three groups had statistically similar preoperative characteristics, including the function of the operated kidney on renal scan. On the discharge day, the PCNL group had the lowest stone-free rate (43.75 %) compared to the laparoscopic (80 %) and open AN groups (92.85 %) (P = 0.009). After a mean follow-up period of 12.1 months, the decrease in the function of the operated kidney was greatest in the open AN group (-8.66 ± 4.97) compared to the laparoscopic AN (-6.04 ± 6.52) and PCNL group (-2.12 ± 2.77) (P = 0.003). The need for ancillary procedures to manage residual stones was greatest in the PCNL group and lowest in the open AN group. A similar trend was seen in overall treatment costs (P < 0.001). For management of large staghorn renal stones, the more invasive the procedure, the higher the one-session stone-free rate and the lower the need for ancillary procedures; however, greater renal functional loss can be anticipated. The need for ancillary procedures is a major determining factor in the overall cost of treatment, which was highest in the PCNL group.

Laparoendoscopic single-site nephrectomy using standard laparoscopic instruments: our initial experience.

PURPOSE: To report our initial experience with laparoendoscopic single-site (LESS) nephrectomy using a GelPOINT single port and standard laparoscopic instruments. MATERIALS AND METHODS: Laparoendoscopic single-site transperitoneal nephrectomy was done for 6 adult patients with a poorly functioning small or hydronephrotic kidney. The procedure was done with the GelPOINT system, which consisted of a wound retractor (Alexis) and GelSeal cap. Standard laparoscopic instruments were used and the renal pedicle was controlled with 10-mm Hem-o-Lok clips. RESULTS: The participants were 3 men and 3 women with the median age of 29.5 years. Laparoendoscopic single-site nephrectomy was successfully done in all the patients without any major complications. Median operation time was 110 minutes (range, 90 to 130 minutes). There was no need for blood transfusion in any patient. The recovery phase was uneventful and all the patients were discharged after a median hospital stay of 2.5 days (range, 2 to 3 days). Renal function remained stable in all the patients after the operation. The incision site healed well on postoperative follow-up. CONCLUSION: Our initial experience with LESS nephrectomy was successful with the use of a GelPOINT single port and standard laparoscopic instruments. This report may remove barriers to further work with the LESS technique and may offer a strategy to help surgeons gain experience with this novel technology.