Transperitoneal laparoscopic heminephrectomy in duplex kidneys: a one centre experience

Laparoscopic transperitoneal heminephrectomy for treatment of the nonfunctioning moiety of duplex kidney in adults: A case series

Purpose

We report the results and experience of a tertiary care center in laparoscopic transperitoneal heminephrectomy for the treatment of a non-functioning upper pole moiety of duplex kidney in adults.

Materials and Methods

The key point of the technique included the placement of a 6-Fr ureteric catheter in the healthy ureter at the beginning of the procedure under fluoroscopic guidance cystoscopically. A standard laparoscopic 3- to 4-port placement was done after placing the patient in a 45 to 90 degrees lateral decubitus position. The upper pole was mobilized transperitoneally and transected using a harmonic scalpel.

Results

A total of 17 patients aged 19 to 44 years underwent laparoscopic upper pole heminephrectomy. All patients had a complete duplicated renal collecting system on the ipsilateral side. Three patients were found to have ureterocele. The average blood loss was minimal (50–150 mL) with a mean of 95 ml. None of the patients required any blood transfusions. The mean operative time was 220 minutes (range, 160–315 minutes). The average length of hospital stay was 3 days (range, 2–4 days). Only 2 patients had Clavien-Dindo grade 3a complications, which were managed by double J stenting and percutaneous aspiration, respectively.

Conclusions

Laparoscopic heminephrectomy is playing a cornerstone role in the treatment of the non-functioning moiety of duplex kidneys. The procedure is safe, efficient and offers the typical preoperative and postoperative benefits of laparoscopic surgery. The rate of complications in adults is acceptable and is similar to that reported in pediatric patients.

Heminephrectomy in Adults: A Systematic Review with Cumulative Analysis

INTRODUCTION

Duplex collecting system of the kidney is a relatively common abnormality, with the majority of symptomatic cases discovered in childhood. Treatment is commonly a heminephrectomy of the affected moiety. We aimed to conduct a systematic review of the literature to provide the best available evidence for heminephrectomy for duplex kidneys in the adult population.

MATERIALS AND METHODS

A literature search was conducted in September 2017 with no limitations being placed on language, region, date or publication type. Data were represented numerically and analysed cumulatively.

RESULTS

Seven retrospective studies with 66 patients were included. Of which, 56/66 operations were performed laparoscopically, 5/66 were robot-assisted and 5/66 were open procedures. Complete resolution of symptoms was reported in 53/55 (96.4%) of patients in five studies providing outcome data. Of the 6 studies reporting complications, there were a total of 9 complications (9/62, 14.5%), however 5 of these were found to be in one study alone.

CONCLUSIONS

This review emphasises the scarcity of evidence for heminephrectomy in adults. Nonetheless, it has been shown that this operation may be effective in alleviating patients' symptoms in addition to being safe in experienced hands.