Laparoscopic Nephrectomy for Benign Renal Diseases: An Initial Experience

Abstract

Objective:  To evaluate the safety and efficacy of Laparoscopic nephrectomy for benign renal diseases at Department of Urology Post Graduate Medical Institute / Lahore General Hospital Lahore.

Introduction:  Since the first laparoscopic performed by Clayman in 1991¹ for a benign kidney disease. Lap-aroscopic Nephrectomy became a procedure of choice for both the benign and malignant renal diseases. As well as the live kidney donation developed rapidly lap-arascopically. This surgical procedure has various adv-antages like short hospital, quick post-operative recovery; early return to work and cosmesis. At the same time there are various challenges which include long learning curve conversion to open surgery and other complications. We performed 16 laparoscopic nephre-ctomies for benign renal disease. We analyzed our data according to these parameters operative time, blood loss conversion rate, analgesia requirement in post-operative hospital stay and complications.

Patients and Method:  A total number of 16 patients’ undergone laparoscopic nephrectomy. We use trans-peritoneal approach in all cases. The data was analy-zed regarding preoperative and postoperative variables including operative time, blood loss, complications, hospital stay, conversion rate and analgesia require-ments.

Results:  All patients underwent Transperitoneal Lap-aroscopic Nephrectomy. Out of 16 patients 9 had renal stone disease, four had pelviureteric junction obstruct-tion, and one each had reflux nephropathy, tuberculo-sis and chronic pyelonephritis. The age range was 12 to 55 years with mean age of -27.75 +12.29 years. The blood loss was 50 to 500ml in benign cases with average of 203.44 + 117.5 ml. Conversion rate was 12.5% noted .The hospital was ranging from 3 to 15 days with mean of 5.5 = 3.11 days. Operative time was raging from 100 to 350 minute with mean operative time of 195 + 78.65 min. The surgical complications were port site wound infection in 2 cases, residual stone at specimen extraction site in one case and 2 had surgical emphysema of abdominal wall. Prolong ileus was observed in 2 cases. Specimen extraction site inci-sional was noted in one patient which was repaired.

Conclusion:  Transperitoneal Laparoscopic Nephrectomy is a procedure of choice for inflammatory conditions because of less morbidity short hospital stay reduced analgesia requirement and cosmesis as well as early return to work. The difficulties are dense adhesions in perinephric, hilar region that cause very slow progress, bleeding and conversion to open nephrectomy.