Comparison of transperitoneal and retroperitoneal laparoscopic living donor nephrectomy:

Laparoscopic treatment of bilateral duplex kidney and ectopic ureter: A case report

BACKGROUND

Duplication of the renal pelvis is a common congenital malformation of the urinary system. About one-third of cases are complete unilateral duplication of the renal pelvis, while bilateral duplication is extremely rare. Herein, we described a single case of bilateral renal duplication with double ureteral orifice ectopic vaginal fistula treated with laparoscopy.

CASE SUMMARY

A 6-year-old girl suffering from long-term vaginal leakage was admitted on June 10, 2018. She was diagnosed with complete duplication of both kidneys and ureters and ectopic opening of both ureters combined with ureterovaginal fistula. The patient received laparoscopic ectopic ureteral bladder replantation and was followed up for 2 years. No renal function damage and vaginal leakage were found.

CONCLUSION

Laparoscopic bladder-ureter reimplantation could effectively determine the location and number of ectopic ureters by imaging and cystoscopy.

A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database

Objectives:

While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database.

Patients and methods:

All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed.

Results:

Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss ( p = 0.001), transfusion rate ( p = 0.02) and operative length ( p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy ( p = 0.02), nephroureterectomy ( p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach.

Conclusion:

Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon.

Level of evidence:

4

A comparison of technique modifications in laparoscopic donor nephrectomy: a systematic review and meta-analysis

OBJECTIVE

To compare the effectiveness of different technique modifications in laparoscopic donor nephrectomy.

DESIGN

Systematic review and meta-analyses.

DATA SOURCES

Searches of PubMed, EMBASE, Web of Science and Central from January 1st 1997 until April 1st 2014.

STUDY DESIGN

All cohort studies and randomized clinical trials comparing fully laparoscopic donor nephrectomy with modifications of the standard technique including hand-assisted, retroperitoneoscopic and single port techniques, were included.

DATA-EXTRACTION AND ANALYSIS

The primary outcome measure was the number of complications. Secondary outcome measures included: conversion to open surgery, first warm ischemia time, estimated blood loss, graft function, operation time and length of hospital stay. Each technique modification was compared with standard laparoscopic donor nephrectomy. Data was pooled with a random effects meta-analysis using odds ratios, weighted mean differences and their corresponding 95% confidence intervals. To assess heterogeneity, the I2 statistic was used. First, randomized clinical trials and cohort studies were analyzed separately, when data was comparable, pooled analysis were performed.

RESULTS

31 studies comparing laparoscopic donor nephrectomy with other technique modifications were identified, including 5 randomized clinical trials and 26 cohort studies. Since data of randomized clinical trials and cohort studies were comparable, these data were pooled. There were significantly less complications in the retroperitoneoscopic group as compared to transperitoneal group (OR 0.52, 95%CI 0.33-0.83, I2 = 0%). Hand-assisted techniques showed shorter first warm ischemia and operation times.

CONCLUSIONS

Hand-assistance reduces the operation and first warm ischemia times and may improve safety for surgeons with less experience in laparoscopic donor nephrectomy. The retroperitoneoscopic approach was significantly associated with less complications. However, given the, in general, poor to intermediate quality and considerable heterogeneity in the included studies, further high-quality studies are required.

TRIAL REGISTRATION

The review protocol was registered in the PROSPERO database before the start of the review process (CRD number 42013006565).

Utility of inguinal incision in retroperitoneoscopic live donor nephrectomy

BACKGROUND

Retroperitoneoscopic live donor nephrectomy has been performed in many countries. The purpose of this study was to evaluate the inguinal incision as a route for hand-assisted manipulation and allograft retrieval.

METHODS

From April 2011 to June 2012, a prospective clinical study of 21 cases of retroperitoneal live donor nephrectomy was performed at our hospital. All donors were grouped in a test group (n = 11, inguinal incision) or a control group (n = 10, lumbar incision). The operative time, warm ischaemia time, blood loss, hospital stay, cosmetic satisfaction, incision complications, and recipient's serum creatinines were compared between groups.

RESULTS

All 21 cases of retroperitoneal live donor nephrectomy were accomplished successfully without serious complications. There was no difference in blood loss and operative time between groups. The mean warm ischaemic time and hospital stay was shorter (P < 0.01), and satisfaction with cosmesis was greater (P < 0.05) in the test group. The abdominal asymmetry (4/10) and wound dehiscence occurred only in the control group. The recipient's serum creatinine was lower in the test group at 1 day (P < 0.01) and 3 days (P < 0.05) after transplantation.

CONCLUSION

The inguinal incision offers an ideal route for hand-assisted manipulation and allograft retrieval during retroperitoneoscopic live donor nephrectomy, and has a potential to be generally applied in the future.

Transperitoneal laparoscopic nephroureterectomy for native upper tract urothelial carcinoma in renal transplant recipients

PURPOSE

To analyze the safety and clinical outcome of laparoscopic nephroureterectomy (LNUT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.

METHODS

We conducted a retrospective analysis of 956 RT recipients from January 2003 to December 2010 to evaluate the benefit of LNUT for patients who were diagnosed with de novo UC after renal transplantation.

RESULTS

Women predominated (10/11, 91 %) in the 11 patients with upper tract UC who underwent LNUT. Five patients underwent LNUT ipsilateral to the transplanted kidney, 4 patients underwent contralateral LNUT, and 2 patients underwent bilateral LNUT. Nine were operated with LNUT combining resection of bladder cuff, 2 with right ureteral cancer underwent open ureterectomy with bladder cuff due to severe adhesions attached to the lesion. The mean surgical duration was 184.2 min (105-305), the mean blood loss was 182.3 ml (20-500), and the mean hospitalization time was 6.7 days (5-9). The mean levels of preoperative and postoperative serum creatinine were 0.99 mg/dl (0.78-1.16) and 1.01 mg/dl (0.89-1.18), respectively. No intraoperative complications occurred. One patient died of multiple metastases at 13 months after LNUT. The mean follow-up of the remaining 10 patients after diagnosis was 21.7 months (3-48). Two patients had recurrent bladder cancer and underwent transurethral resection of the tumor. Eight patients showed no evidence of disease during the follow-up.

CONCLUSIONS

LNUT is a safe and effective approach with low morbidity in transplant recipients, and this therapy provides less trauma, quicker recovery, and acceptable oncological outcomes.

Transperitoneal laparoscopic heminephrectomy in duplex kidney: our initial experience

OBJECTIVES

To study the feasibility, safety, and effect of transperitoneal laparoscopic heminephrectomy in the duplex kidney.

METHODS

From December 2003 to January 2008, 18 patients with urinary tract duplex anomalies underwent laparoscopic heminephrectomy using a transperitoneal approach. The sites of surgery consisted of 6 right upper, 2 right lower, 9 left upper, and 1 left lower heminephrectomy. Follow-up studies were performed using renal ultrasonography in all patients.

RESULTS

All patients underwent laparoscopic surgery successfully without conversion to open surgery or intraoperative complications. The mean operative time was 142.8 minutes (range 90-195). The mean estimated blood loss was 196.1 mL (range 20-600), and the mean hospital stay was 6.1 days (range 4-10). In 1 patient, a minor postoperative urine leak resolved spontaneously with prolonged catheter drainage. The radiologic assessment showed normal ipsilateral renal growth in 18 patients at a mean follow-up of 25.8 months.

CONCLUSIONS

Our initial clinical experience suggests that laparoscopic heminephrectomy using a transperitoneal approach for the duplex kidney is feasible, safe, and effective. Therefore, the transperitoneal approach for moiety excision, which offers a technically simple approach for complete ureterectomy, is recommended.