Laparoscopic Nephrectomy in Patients with Previous Abdominal Surgery.

Laparoscopic nephrectomy is a minimally invasive procedure that provides significant benefits to the patient, such as reduced analgesic requirements and shorter recovery time. While the popularity of laparoscopy has grown substantially, there are associated risks of injury to the blood vessels and/or viscera during the insertion of the laparoscopic ports. Such injuries can lead to a significant increase in mortality rates. Patients who have had previous abdominal surgery have a higher risk of adhesions; this has been shown to increase the risk of complications from port placement. Consequently, previous abdominal surgery was viewed as a relative contraindication to laparoscopic surgery. However, studies have demonstrated the advantages of laparoscopic surgery over an open radical approach; hence, previous abdominal surgery is no longer viewed as a contraindication. Here, we describe the case of a 62-year-old man who presented with an incidental finding of right renal cell carcinoma (RCC). We performed a radical nephrectomy on this patient who had undergone multiple previous abdominal surgeries. During this procedure, a small bowel injury occurred. Herein, we review the available evidence and describe the risk factors and techniques to avoid injury from laparoscopic port-site placement in patients undergoing nephrectomy with a history of previous abdominal surgery.

Laparoscopic Nephrolithotomy in a Horseshoe Kidney.

Horseshoe kidney (HSK) is the common renal fusion congenital anomaly, affecting about 0.25% of the global population. Although most HSKs are detected incidentally, they may present with clinical findings, including urinary tract infections (UTI), stone formation, and obstruction. Nephrolithiasis, observed in 20% of patients with HSK, is a frequent indication for surgery. Due to the caudal and medial locations of calyces and the abnormal anterior position of the kidney, extracorporeal shock wave lithotripsy has shown a relatively low success rate in treating HSK. Percutaneous nephrolithotomy has also been associated with major complications in anomalous kidneys. Advances in laparoscopic instrumentation and techniques have made laparoscopic surgery a promising alternative for stone treatment in HSK. This report describes a 61-year-old woman who presented initially with recurrent UTI unresponsive to multiple courses of antibiotics. Urine cultures were positive for Escherichia coli. A computed tomography scan showed a right HSK with multiple renal stones (35 mm in the right lower pole with eight stones 2-4 mm in size), along with severe hydronephrosis. The patient was treated successfully with laparoscopic nephrolithotomy, indicating that laparoscopy is an effective and safe approach in the treatment of renal stones >2 cm in HSK.

Tissue factor and tissue factor pathway inhibitor in women with a past history of preeclampsia: implication for a hypercoagulable state postpregnancy.

Preeclampsia (P-EC) is a multisystem disorder of pregnancy whose cause and pathogenesis remain poorly understood. However, abnormal haemostasis and endothelial dysfunction are thought to be implicated. Women with a past medical history of P-EC have a baseline hypercoagulable state postpregnancy. The aim of this study is to examine the relationship between tissue factor (TF) and TF pathway inhibitor (TFPI) in women who have had P-EC within the last 3 years (more than 6 months postpartum) and their normal counterparts. Blood specimens were collected from women known to have had P-EC within the last 3 years (n = 26) and aged-matched healthy women without past history of P-EC in previous pregnancy (n = 26). Plasma TF and TFPI levels were measured using ELISAs. Women who have had P-EC showed increased TF levels compared with their normal counterparts, whereas TFPI levels were reduced. Neither parameter differed significantly when the groups were tested against each other. Interestingly, the TF/TFPI ratio was significantly increased (P = 0.024) when the two groups were compared. In summary, there was a trend towards increased TF and reduced TFPI levels in the P-EC group. Such a tendency was not statistically significant. However, the TF/TFPI ratio was significantly increased when the groups were compared. Our findings suggest an imbalance between TF/TFPI levels in women with past history of P-EC postpregnancy. This may contribute to the development of maternal hypercoagulable states and may predispose women with a history of P-EC to cardiovascular risks later in life.