Laparoscopic nephrectomy and nephro-ureterectomy. Argument for morselation or retrieval of intact specimens

Abstract

Vaginal retrieval of the intact specimen following laparoscopic nephrectomy for malignant disease holds definite advantages as there is little risk of peritoneal or wound contamination with malignant cells. The technique of vaginal removal is relatively easy and may well prove quicker than morselation within a peritoneal bag. We have compared these two techniques over a range of patients with both benign and malignant pathology. Female patients undergoing laparoscopic nephrectomy were divided into two groups. In the first group the kidney was placed within an intraperitoneal bag and finely divided with scissors prior to removal via an abdominal portal. Vaginal removal of the intact specimen was used in the second group. Six patients had their kidneys removed after morselation, eight had vaginal retrieval. Twelve had benign renal disease, while two who had transitional cell carcinoma of their renal pelvis underwent laparoscopic nephro-ureterectomy and both specimens were retrieved intact via the vaginal route. We compare and contrast the two techniques, concluding that vaginal retrieval has significant advantages over conventional retrieval.