Laparoscopic nephrectomy for benign renal disease

Abstract

To perform nephrectomies in patients with benign renal conditions using laparoscopic techniques. A total of five patients with benign renal conditions were treated. Three of the patients were morbidly obese. The operative technique was similar to a transperitoneal nephrectomy and was performed through four to six abdominal ports. Initial dissection involved mobilization of the overlying right colon to expose the retroperitoneum. Early identification of the inferior vena cava and ureter was critical to subsequent dissection and particularly to the exposure of the renal vessels. These vessels were controlled by either Endo-GIA staples (Autosuture Co., USA) or vicryl ties and haemaclips prior to division. After control of the vascular pedicle the kidney was mobilized within Gerota's fascia and removed. In three patients the procedure was performed entirely laparoscopically with retrieval of the kidneys through dilated abdominal port sites. Small incisions were necessary in the remaining two patients--one with a grossly hydronephrotic kidney and the other, a morbidly obese woman with co-existing cholelithiasis, treated laparoscopically also had an epigastric hernia which was repaired using a 5 cm incision through which her kidney and gall-bladder were removed. Operative times ranged from 2 to 4 1/2 h. Narcotic analgesia was required in two cases and the median post-operative stay was 2 days. A superficial skin infection in one patient was the only post-operative complication. Laparoscopy appears to have a definite role in the selective removal of kidneys for benign renal disease. Based on our experience this technique is particularly useful in the obese patient--reducing post-operative pain and allowing early mobilization, discharge from hospital and resumption of normal activities.