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S148 Laparoscopic nephrectomy
S148
Laparoscopic nephrectomy Eur Urol Suppl 2013;12;e1256
Anakievski D., Kosev P., Sandulov A., Chankov P., Hinev A. St. Marina University Hospital, Clinic of Urology, Varna, Bulgaria INTRODUCTION & OBJECTIVES: In the new millennium the laparoscopic surgery was established as a highly effective mini-invasive method of treatment of various urological diseases, including those of the kidneys. The aim of our study was to summarize and present our initial experience with the laparoscopic nephrectomy, in all its variations. MATERIAL & METHODS: Between July 2008 and July 2013 a total of 33 laparoscopic nephrectomies were performed in our clinic. Ten of the patients were men, and 23 – women, at a mean age of 54.2 years /range 24 - 76 years/. The main indication for the nephrectomy was the presence of a malignancy /9 cases/, or a non-functioning kidney that was either hydronephrotic /19 cases/, or nephrosclerotic /5 cases/. Transperitoneal approach was used in 32 of the cases, and only one of the patients was operated extraperitoneally. Surgery was performed via 3-4 abdominal ports, supplemented in some women by an additional 10/12/-mm transvaginal port. A minimal incision in the lower abdomen and “endo-bag” were used in 18 cases, while in all of the rest the kidney was removed without additional skin incisions: either via the vagina /6 cases/, or by its division in pieces in the abdominal cavity with subsequent extraction of all fragments via the 10-mm abdominal port /9 cases/. RESULTS: Most of the operations were implemented with minimal blood loss, within a mean operative time of 115 ± 35 (SD) min. Conversion to open surgery, due to uncontrolled bleeding during division of the vascular pedicle, was needed in 1 patient only. Another case of unrecognized injury of the epigastric vessels led to the formation of hematoma on the abdominal wall and also required open revision. In the rest of the patients the postoperative period ran smoothly and without complications. The follow up examinations confirmed the excellent cosmetic effect of the laparoscopic procedures performed. CONCLUSIONS: As compared to open surgery, laparoscopic nephrectomy offers some distinct advantages: excellent cosmetic effect, minimal surgical trauma, reduced blood loss, short convalescent period, and a rapid recovery of patient physical activity. Therefore, it currently turns to be the most preferable surgical method – both for doctors and patients.
Laparoscopic nephrectomy Eur Urol Suppl 2013;12;e1256
Anakievski D., Kosev P., Sandulov A., Chankov P., Hinev A. St. Marina University Hospital, Clinic of Urology, Varna, Bulgaria INTRODUCTION & OBJECTIVES: In the new millennium the laparoscopic surgery was established as a highly effective mini-invasive method of treatment of various urological diseases, including those of the kidneys. The aim of our study was to summarize and present our initial experience with the laparoscopic nephrectomy, in all its variations. MATERIAL & METHODS: Between July 2008 and July 2013 a total of 33 laparoscopic nephrectomies were performed in our clinic. Ten of the patients were men, and 23 – women, at a mean age of 54.2 years /range 24 - 76 years/. The main indication for the nephrectomy was the presence of a malignancy /9 cases/, or a non-functioning kidney that was either hydronephrotic /19 cases/, or nephrosclerotic /5 cases/. Transperitoneal approach was used in 32 of the cases, and only one of the patients was operated extraperitoneally. Surgery was performed via 3-4 abdominal ports, supplemented in some women by an additional 10/12/-mm transvaginal port. A minimal incision in the lower abdomen and “endo-bag” were used in 18 cases, while in all of the rest the kidney was removed without additional skin incisions: either via the vagina /6 cases/, or by its division in pieces in the abdominal cavity with subsequent extraction of all fragments via the 10-mm abdominal port /9 cases/. RESULTS: Most of the operations were implemented with minimal blood loss, within a mean operative time of 115 ± 35 (SD) min. Conversion to open surgery, due to uncontrolled bleeding during division of the vascular pedicle, was needed in 1 patient only. Another case of unrecognized injury of the epigastric vessels led to the formation of hematoma on the abdominal wall and also required open revision. In the rest of the patients the postoperative period ran smoothly and without complications. The follow up examinations confirmed the excellent cosmetic effect of the laparoscopic procedures performed. CONCLUSIONS: As compared to open surgery, laparoscopic nephrectomy offers some distinct advantages: excellent cosmetic effect, minimal surgical trauma, reduced blood loss, short convalescent period, and a rapid recovery of patient physical activity. Therefore, it currently turns to be the most preferable surgical method – both for doctors and patients.