Posterior approach for retroperitoneal laparoscopic bilateral native nephrectomy in prone position: initial...

Area of Science:

• Nephrology
• Minimally Invasive Surgery
• Transplantation Surgery

Background:

• Focal segmental glomerulosclerosis (FSGS) recurrence post-kidney transplant is a significant clinical challenge.
• Native nephrectomy is sometimes performed before transplantation to mitigate FSGS recurrence risk.
• Laparoscopic surgery offers a minimally invasive alternative to traditional open procedures.

Observation:

• This study reports the initial experience with four FSGS patients undergoing simultaneous bilateral native nephrectomy.
• The procedure was performed laparoscopically in the prone position using a retroperitoneal approach.
• Adequate surgical visualization and working space were achieved, without the need for patient repositioning.

Findings:

• The laparoscopic retroperitoneal approach facilitated specimen removal via port extension or morcellation.
• Mean operative time was 325 minutes, with an average blood loss of 281 mL.
• Patients demonstrated rapid recovery, resuming oral intake in 1.3 days and ambulating on postoperative day 1, with no major complications.

Implications:

• Simultaneous bilateral laparoscopic native nephrectomy in the prone position is a safe and effective option for FSGS patients.
• This technique may offer advantages in managing FSGS recurrence risk prior to renal transplantation.
• Further studies are warranted to establish the long-term efficacy and broader applicability of this approach.