Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience

Abstract

Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys.Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed.Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes) and the mean estimated blood loss was 134 mL (80-650 mL).The mean postoperative hospital stay was 3.6 days (3-5days) and the mean return to normal activity was 11.6 days (10-14days). Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months) follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur.Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys.

Peer Review #1 of "Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients (v0.1)"

“…Manuscript to be reviewed results show a longer operation time in laparoscopic group (median 180min) than open group (median 135 min) that is consistent with the result of Hemal's study to a certain extent (Hemal et al 2000). However, compared with existing reports in which surgical time of laparoscopic approach ranged from mean 92 min to mean 244 min (Lee et al 2002;Tian et al 2015;Zhang et al 2005b), the median time of our operations was 180 min and this difference may be due to the selection of patients or the surgical experience.…”

Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients

“…In addition, our results show a longer operation time in laparoscopic group (median 180 min) than open group (median 135 min) that is consistent with the result of Hemal’s study to a certain extent (Hemal, Gupta & Kumar, 2000). However, compared with existing reports in which surgical time of laparoscopic approach ranged from mean 92 min to mean 244 min (Lee et al, 2002; Tian et al, 2015; Zhang et al, 2005b), the median time of our operations was 180 min and this difference may be due to the selection of patients or the surgical experience.…”

“…Then Zhang et al (2005a) reported 12 successful retroperitoneoscopic nephrectomies without conversion to open operation for an infective nonfunctioning kidney with dense perinephric adhesions. Additionally, they also confirmed the operability and advantages of retroperitoneal laparoscopic nephrectomy for renal tuberculosis by comparing 22 successful laparoscopic with 22 open nephrectomies (Zhang et al, 2005b) Recently Tian et al (2015) reported 51 consecutive patients with tuberculous nonfunctioning kidney treated by laparoscopic nephrectomy and there was only one case required conversion to open surgery due to non-progression of dissection. The present research presented nearly 10 percent of conversion to open surgery and the good news is all these surgical conversion resulted from uncompleted dissection of the severe adhesions without any vascular injury or visceral injury.…”

The Harbin Medical University nephrectomy score: a quantitative system for evaluating the complexity of laparoscopic retroperitoneal simple nephrectomy

“…Perinephric and perihilar inflammation are the main concerns when performing LRSN ( 9 , 10 ). Of the benign diseases that lead to the loss of kidney function, some, such as congenital anomalies, vascular pathologies, and systemic hypertension, were preferred by surgeons due to no or little inflammation.…”