Simple nephrectomy is performed for a benign pathology that does not require the excision of either the adrenal gland or of any adenopathies. When it is carried out in cases of stone disease, however, it is very frequently not a "simple" technique owing to the presence of significant inflammation and infection.
Ninety-six simple laparoscopic nephrectomies performed because of stone disease between 2006 and 2015 were retrospectively studied. A descriptive statistical analysis was performed, as well as an evaluation of the associated complications.
Of the 96 laparoscopic nephrectomies (62 left, 34 right), seven (7.2%) had to be converted into open surgery owing to the impossibility of dissecting the renal hilum because of xanthogranulomatous pyelonephritis (n=4) or major associated lesions (n=3). The indication for nephrectomy was lumbar pain associated with urinary infection, with a partial renal function below 15% assessed by DMSA renal scan. There were three major complications. Pathological assessment revealed chronic pyelonephritis with kidney atrophy and associated pyonephrosis in 85 cases, xanthogranulomatous pyelonephritis in 10 and pT4 squamous cell carcinoma in 1.
Despite its high technical difficulty, simple laparoscopic nephrectomy for stones is a viable technique for advanced laparoscopists. Its principal advantage compared with open surgery is improved post-surgical recovery, and it is associated with an acceptable complication rate. Xanthogranulomatous pyelonephritis is not an initial contraindication to laparoscopy, but it is the most significant risk factor for conversion to open surgery.
Journal of endourology / Endourological Society. 2016 Aug 01 [Epub ahead of print]
Oriol Angerri, Juan Manuel Lopez-Martinez, Francisco Sanchez-Martin, Felix Millan, Antoni Rosales, Humberto Villavicencio
Fundacio Puigvert, Urology , Cartagena 340 , Barcelona, Spain , 08025 ; ., Fundació Puigvert, Department of Urology, Barcelona, Spain ; ., Fundacio Puigvert, Urology, Barcelona, Spain ; ., Fundacio Puigvert, Urology , Cartagena 340 , Barcelona, Spain , 08025 ; ., Fundacio Puigvert, Urology , c/Cartagena 340-350 , Barcelona, Barcelona, Spain , 08025., Fundacio Puigvert, Urology, Barcelona, Spain ; .