MGM Journal of Medical Sciences (Jan 2020)
Transperitoneal laparoscopic nephrectomy for benign nonfunctioning kidney: Our experience with 84 cases
Abstract
Background: The transperitoneal laparoscopic nephrectomy provides an optimal working space. It facilitates orientation by extending identifiable anatomic landmarks. The study evaluates the safety, outcome, and complications of the procedure. Materials and Methods: A total of 84 patients with benign nonfunctioning kidney admitted from April 1, 2015 to March 31, 2019 in the Department of Urology, MGM Medical College and Hospital, Navi Mumbai, India were considered for study purposes. The exclusion criteria of the study included uncorrected coagulopathy, active urinary tract infection, pregnancy, and severe cardiopulmonary disease. Preoperative imaging included digital X-ray, kidney ureter bladder, ultrasonography, intravenous pyelogram, computed tomography, intravenous urogram, micturating cystourethrogram, and diethylenetriaminepentaacetic acid renal scan. All operated patients were evaluated for intraoperative and postoperative complications. Results: The mean age of patients was 40.76 years. Of 84 patients, 60 were men and 24 were women. Patients had complaints of ipsilateral flank pain 76 (90.47%), lower urinary tract symptoms 34 (30.95%), and hematuria 18 (21.42%). Causes of benign nonfunctioning kidney were obstructive uropathy secondary to stone in 62 patients (73.81%) followed by neglected pelvic ureteric junction obstruction in 8 (9.53%), renal tuberculosis in 6 (7.14%), chronic pyelonephritis in 6 (7.14%), and renovascular hypertension in 2 (2.38%) patients. Seven patients required conversion to open surgery, secondary to adhesions in four patients, instrument failure in one case, and bleeding in two cases. The mean stay of the patient in the hospital was 4.38 days. Various types of complications occurred in five patients: colonic injury in one, wound infection in three, and incisional hernia in one. Conclusion: Transperitoneal laparoscopic nephrectomy is an effective procedure with minimal morbidity, hospital stay, rapid recovery, and better cosmesis making this the gold standard technique for nephrectomy.
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