Laparoscopic nephrectomy for inflammatory renal conditions
B Shekarriz1, M V Meng, H F Lu
1Department of Urology, University of California-San Francisco School of Medicine, San Francisco, California 94143-0738, USA.
Purpose:
Inflammatory and infectious renal conditions may result in severe perirenal fibrosis, making the laparoscopic approach challenging. The theoretical advantages of laparoscopy for managing inflammatory and infectious renal conditions have been questioned. We identified whether laparoscopy for inflammatory renal conditions is associated with higher morbidity than for other benign renal conditions. Furthermore, several technical modifications are discussed that may help to improve the outcome.
Materials And Methods:
We retrospectively reviewed the records of all patients who underwent laparoscopic nephrectomy for inflammatory and infectious renal conditions between 1998 and 2000. The transperitoneal approach was used and specimens were removed after morcellation. Operative data were compared with those from a similar group of patients who underwent laparoscopic nephrectomy for other benign conditions.
Results:
Laparoscopic nephrectomy done for inflammatory or infectious conditions in 12 cases and for other benign conditions in 9 matched cases was completed successfully in 10 (83%) and 9 (100%), respectively. In the inflammatory and benign groups mean blood loss plus or minus standard deviation was 155 +/- 163 and 59 +/- 23 ml. (p = 0.099), mean operative time was 284 +/- 126 and 226 +/- 62 minutes (p = 0.225), and mean postoperative hospital stay was 4.1 +/- 2 and 3 +/- 1 days (p = 0.157), respectively.
Conclusions:
Laparoscopic nephrectomy can be performed safely in most cases of inflammatory renal conditions. Although they were not statistically significant, a higher conversion rate and longer operative time should be expected. Early conversion may be required due to failure to progress. Similar advantages were observed in patients with inflammatory and other benign renal conditions via the laparoscopic approach.
Insights
Laparoscopic nephrectomy is safe for inflammatory renal conditions, though conversion rates and operative times may be higher. Technical modifications can improve outcomes in these challenging cases.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrology
Background:
- Perirenal fibrosis from inflammatory/infectious renal conditions complicates laparoscopic surgery.
- The efficacy of laparoscopy for these conditions is debated.
Purpose of the Study:
- To determine if laparoscopy for inflammatory renal conditions has higher morbidity than for other benign renal conditions.
- To discuss technical modifications for improved laparoscopic outcomes in inflammatory renal cases.
Main Methods:
- Retrospective review of laparoscopic nephrectomies for inflammatory/infectious renal conditions (1998-2000).
- Comparison with matched cases of laparoscopic nephrectomy for other benign renal conditions.
- Transperitoneal approach with specimen morcellation.
Main Results:
- Successful laparoscopic nephrectomy in 83% of inflammatory cases vs. 100% of benign cases.
- Higher mean blood loss (155 vs. 59 ml) and operative time (284 vs. 226 min) in inflammatory cases, though not statistically significant.
- Longer postoperative hospital stay in inflammatory cases (4.1 vs. 3 days), also not statistically significant.
Conclusions:
- Laparoscopic nephrectomy is generally safe for inflammatory renal conditions.
- Expect potentially higher conversion rates and longer operative times, with early conversion sometimes necessary.
- Laparoscopic approach offers similar advantages for inflammatory and benign renal conditions.
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