Retroperitoneoscopic Nephrectomy in Dialysis Dependent Patients and Comparison with Open Surgery
Tawatchai Taweemonkongsap MD*, Chaiyong Nualyong MD*, Teerapon Amornvesukit MD*, Sittiporn Srinualnad MD*, Phichaya Sujijantararat MD*, Suchai Soontrapa MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Objective : To evaluate the surgical outcomes and morbidity of retroperitoneoscopic nephrectomy compared
with open nephrectomy for dialysis dependent patients.
Material and Method: Between November 2002 and August 2007, 14 hemo or peritoneal dialysis patients
underwent nephrectomy or nephroureterectomy at Siriraj Hospital. Of the 14 patients, seven were treated with
retroperitoneoscopic nephrectomy and seven with open nephrectomy. A retrospective review and data were
carried out. The patient factors, type of surgery, perioperative outcomes and complications were analyzed.
Results : There was no conversion rate in the retroperitoneoscopic group. The mean estimated blood loss,
analgesic requirement and time before starting oral intake were lower in the retroperitoneoscopic group
(141.4 + 95 versus 292.8 + 226 ml, 5.0 + 4.5 versus 7.6 + 1.9 mg and 14.5 + 16.1 versus 23.1 + 23.3 hours,
respectively). On the other hand, the mean operative time in the retroperitoneoscopic group was longer than
the open group but with no significant difference (177.14 + 51 versus 160.71 + 84min, p = 0.521). Two
patients in the open group required intraoperative blood transfusion. There were two complications. One
patient developed a large retroperitoneal hematoma after retroperitoneoscopic nephrectomy. Another had a
perivesical collection in the open nephrectomy group. No mortality related to the procedures occurred.
Conclusion : Retroperitoneoscopic nephrectomy should be considered as the procedure of choice for dialysis
dependent patients. This has all the benefits of minimally invasive surgery such as reduced blood loss, minimal
post operative pain leading to faster convalescence.
Keywords : Retroperitoneoscopy, Nephrectomy, Dialysis, Laparoscopy
