J Med Assoc Thai 2012; 95 (4):607

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Laparoendoscopic Single-Site Nephrectomy for Patients with Dialysis-Dependent End Stage Renal Disease
Permpongkosol S Mail, Nontakaew K

Objective: Assess the feasibility, safety, and outcome of laparoendoscpic single-site (LESS) nephrectomy in high-risk patients with end-stage renal disease (ESRD), who have undergone continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) treatment.

Material and Method: Between October 2009 and January 2010, a 62-year-old female and a 36-year-old male that had undergone CAPD and HD, respectively, consecutively underwent LESS nephrectomies. The medical records of the two patients were retrospectively reviewed. The indications for nephrectomy were that the non-functioning kidney was associated with a ureteric stone and distal ureteric stricture, respectively. Parameters examined were patient demographics, medical co-morbidities, operative outcomes, and complications.

Results: All procedures were completed successfully via transumbilical LESS laparoscopy. The operative times were 160 and 200 minutes, blood loss 200 and 50 mL, and postoperative hospital stay 6 and 14 days, respectively. No intraoperative complications were reported. The first patient who used CAPD before LESS nephrectomy for whom CAPD was successfully reinstated within two weeks postoperatively. No other catheter-related complications occurred. The second patient required a reoperation to evaluate the active bleeding on the fifth post-operative day, but could not find any blood vessel injuries. The bleeding was stopped from the platelet replacement. Pathological evaluation revealed chronic glomerulonephritis in each case.

Conclusion: Less nephrectomy is a feasible technique with the advantages of less pain, shortened convalescence, improved cosmesis, and absence of wound complications.

Keywords: Laparoendoscopic single site surgery, Nephrectomy end stage renal disease, Continuous ambulatory peritoneal dialysis

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