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Minimally invasive nephrectomy for inflammatory renal disease

Asian Journal of Urology 2020年第4期7卷 345-350页

作者： Paula Andrea Pena Lynda Torres-Castellanos german patino Stefania Prada Luis Gabriel Villarraga Nicolas Fernandez Pontificia Universidad Javeriana School of MedicineBogota D.C.Colombia Department of Urology Hospital Universitario San IgnacioPontificia Universidad JaverianaSchool of MedicineBogota D.C.Colombia Division of Urology Hospital Universitario San IgnacioPontificia Universidad JaverianaBogota D.C.Colombia Division of Urology Hospital Universitario San IgnacioPontificia Universidad JaverianaSchool of MedicineBogota D.C.Colombia Department of Urology Fundacion Santa Fe de BogotaColombia Division of Urology Hospital for SickKidsUniversity of TorontoTorontoCanada

Objective:Once chronic inflammatory renal disease(IRD)develops,it creates a severe peri-fibrotic process,which makes it a relative contraindication for minimally invasive surgery(MIS).Our objective is to show that laparoscopic nephrectomy(LN)is a surgical option in IRD with fewer complications and better outcomes.Methods:Retrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed.Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition(xanthogranulomatous pyelonephritis,chronic nephritis,and renal tuberculosis).We describe intra-operative variables such as operative time,blood loss,conversion rate,postoperative complications and length of hospital stay.Results:There were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD.We identified four(8%)major complications;three of them required transfusion and one conversion to open surgery.The mean operative time was 233108 min.Mean estimated blood loss was 206242 mL excluding the conversion cases and 281423 mL including them.The mean length of hospital stay was 3.02.0 days.Conclusion:Laparoscopic nephrectomy for IRD can safely be done.It is a reproducible technique with low risks and complication rates.Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.

关键词： Inflammation Kidney diseases Laparoscopy Minimally invasive surgical procedures Nephrectomy Nephritis Nephroureterectomy

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