Laparoscopic nephrectomy: technique and outcome

To review case series of retroperitoneal laparoscopic nephrectomies.

Between May 2003 and May 2006, 60 laparoscopic nephrectomies were performed by a single surgeon. Laparoscopic route for nephrectomy was retroperitoneal in 50 cases and transperitoneal in 10 cases.

The patients included 37 males and 23 females. The mean age was 18.5 +/- 16.6 years and ranged from 2 years to 60 years. Right sided nephrectomy was performed in 31 cases while left kidney was removed in 29 cases. The indications for nephrectomy were stones (n = 29), dysplasia (n = 11), chronic pyelonephritis (n = 8), pelvi ureteric junction obstruction (n = 4), tuberculosis (n = 3), vesicoureteric reflux (n = 3) and ureterocele(n = 2). Mean operating time for laparoscopic nephrectomy alone was 140 +/- 51.1 min (range 25-300 minutes). In our series, 19 additional surgical procedures were performed under the same general anaesthesia. The mean hospital stay for all patients was 3.1 +/- 2.39 days; however the mean hospital stay for those patients who underwent laparoscopic nephrectomy without any additional procedure is 2.2 +/- 0.92 days (1.5-4 days). The mean size of kidney removed was 7.4 +/- 3.13 cm (4.6-15.9 cm). Complications were seen in 2 patients (3%); one developed wound infection and the other was found to have a haematoma for which the wound was re-explored. Conversion to open nephrectomy was required in 7 patients (11.6%) due to bleeding from renal pedicle (n = 4), poor vision secondary to pus spillage from pyonephrotic kidney (n = 2) and failure to progress due to indwelling percutaneous nephrostomy. There was no mortality and none of the patients had prolonged ileus. Blood transfusion was not required in any case. There was no bowel injury or port site herniation.

Laparoscopic nephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and hence rapid return to normal activity is expected.