Laparoscopic heminephrectomy for benign renal anomalies

Benign renal conditions, such as duplication and fusion anomalies, are relatively common and may lead to problems such as chronic flank pain or urinary tract infection. Traditional management of these conditions has been open surgical removal of the affected moiety. As an alternative, we report on our experience with laparoscopic heminephrectomy for benign renal anomalies and emphasize the technical aspects of the procedures.

We retrospectively reviewed the records of patients who underwent laparoscopic heminephrectomy for benign renal anomalies at our institution between February 1999 and April 2009.

Heminephrectomy was performed in 11 patients, including 8 with duplicated collecting systems, 2 with horseshoe kidneys, and 1 with a cross-fused renal ectopic kidney. Median operative time was 204 minutes, and median estimated blood loss was 250 mL. There were no intraoperative complications. The presenting symptoms resolved in all patients. There were three major and two minor postoperative complications, including 50% loss of remaining ipsilateral renal parenchyma, postoperative neuralgia and anejaculation, urinoma, and partial wound separation. Median length of hospital stay was 2 days. Renal function was well preserved in all patients. The median change in serum creatinine level was 0.1 mg/dL.

Although laparoscopic heminephrectomy is challenging because of the variable blood supply and abnormal anatomy of the kidney, with careful planning and attention to detail, the procedure is safe and effective for the management of a wide range of benign renal anomalies that necessitate heminephrectomy and offers the usual recovery advantages of laparoscopy.