Laparoscopic Renal Surgery: Ramathibodi Hospital Experience
Kittinut Kijvikai MD*, Suthep Patcharatrakul MD*, Charoen Leenanupunth MD*, Wachira Kochakarn MD*, Suchart Chaimuangraj MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Objective : To report the authors’ early experience of laparoscopic renal surgery for benign and malignant
renal conditions.
Materials and Methods : Laparoscopic renal surgery was performed on 24 patients with benign and malignant
renal conditions between July 2004 and February 2005. The patient characteristics and perioperative data
including operative time, blood loss, analgesic requirement, complications, duration of postoperative drain
removal, length of hospital stay, and duration to return to normal activity were all recorded.
Results : Laparoscopic simple nephrectomy was performed in 15 patients with nonfunctioning benign renal
conditions. Three operations of hand-assisted laparoscopic radical nephrectomy and one of partial nephre-
ctomy were performed for large and small renal cell carcinoma, respectively. Transitional cell carcinomas
were managed by retroperitoneoscopic nephrectomy or hand-assisted approach in 3 cases. For a case of
severe inflammatory renal condition, hand-assisted approach was used for treatment. Laparoscopic renal cyst
decortication was performed in one case. In the laparoscopic simple nephrectomy group, the mean operative
time was 126 + 38.3 minutes. The median (range) estimated blood loss was 100 (50-500) mL, and one patient
required conversion to open surgery because of renal vein injury.
In three cases of hand-assisted laparoscopic radical nephrectomy, the operation time was 315, 325
and 150 minutes and the operative blood loss was 500, 1000 and 200 ml, respectively. In cases of hand-
assisted laparoscopic partial nephrectomy, the operation time and the operative blood loss were 220 minutes
and 350 ml, respectively. In three cases of transitional cell carcinoma, the operation time was 120, 140 and
150 minutes and the operative blood loss was 100, 150 and 150 ml. The surgical margins of all resected
specimens for malignant tumors were negative and no major complication was recorded. Simple renal cyst
decortication was successfully performed within 90 minutes of operation time and bleeding 50 ml. In cases
of severe inflammatory renal condition performed by hand-assisted approach, the operative time was 250
minutes and the operative blood loss was 250 ml.
Conclusion : Laparoscopic renal surgery is a safe and efficacious approach for resection of benign non-
functioning kidneys and malignant renal tumors.
Keywords : Laparoscopic renal surgery, Partial nephrectomy, Nephroureterectomy, Radical nephrectomy, Renal cyst decortication
