الفهرس 
History of Laparoscopy in UrologyOnly 14 pages are availabe for public view
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Abstract
This study was conducted to evaluate the experience of Mansoura Urology and Nephrology Center in laparoscopic simple nephrectomy. Four hundred cases for benign renal pathology were performed over 15 years. The transperitoneal route was offered in 264 (66%) cases while the retroperitoneal approach in 136 (34%). Regarding the transperitoneal approach, the main indication was hydronephrosis in 62% of patients. Aspiration of marked hydronephrotic kidneys was required in 17.8%. It was performed for 2 ectopic kidneys. The mean operative time was 159 minutes; it was affected by the renal pathology and learning curve. The average blood loss was 83.7 c.c.; it was affected by presence of abdominal scars of previous surgery. The procedure was completed laparoscopically in 238 patients reporting success rate of 90.2%. Conversion to open surgery was required in 18 (6%) patients. It was emergent due to vascular injury in 7 patients, splenic injury in 1 and extraperitoneal insufflation in another. While it was elective in 9 due to failure of progression. This was dependant mainly on renal pathology. Reintervention was performed in 8 (3%) patients. It was due to colonic perforation in one, while in the other 7, it was due to bleeding and hypovolemic shock. After statistical analysis, we found that the learning curve is only the independent factor for the outcome. The average hospital stay was 3 days. The pathology of such cases was end stage kidney disease except in 3 that was renal tumors.While in the retroperitoneal approach, the main indication was pretransplantation nephrectomy in 48.5%. The mean operative time was 100.5 minutes. The average blood loss was 67 c.c. The procedure was completed laparoscopically in 126 patients reporting success rate 92.6%. Conversion to open surgery was required in 3 (2%) patients; 1 was explored due to colonic injury during extraction of the specimen, in another case the surgeon extended port site to extract the kidney while in the last case was due to failure of progression in view of marked adhesions. Reintervention was required in 7 (5%) patients. In 1, it was due to colonic perforation, while in the other 6, it was due to bleeding. After statistical analysis, we found that the presence of scar of previous surgery is the only independent factor for outcome. The average hospital stay was 2.7 days. Forty-four patients below the age of 18 years underwent laparoscopic nephrectomy including 5 cases of heminephrectomy. The transperitoneal route was offered in 18 cases (40.9%), while the retroperitoneal approach was carried out in 26 patients (59.1%). The procedure was completed laparoscopically in 41 patients reporting success rate 93.2%. The mean operative time was 118 minutes, while average blood loss was 68 c.c. and mean hospital stay was 2.4 days. We also performed successfully laparoscopic donor nephrectomy in 3 adult donors. We followed up 40 patients in whom en bloc ligation of renal hilum was performed, and we found that there was no evidence of development of arteriovenous malformations at the site of nephrectomy bed.In conclusion, the laparoscopic approach to simple nephrectomy is applicable to many forms of benign pathology, with significant patient benefits such as superior cosmoses, shortened hospital stays, and decreased convalescence times. However, as with any surgical procedure, careful preoperative patient evaluation is necessary to plan the proper approach and maximize the chances for success. The surgeon should always keep in mind the limitations of laparoscopy and apply the approach judiciously when faced with a situation where significant inflammation may be involved. Laparoscopic nephrectomy has become a standardized procedure. It should be offered as the primary treatment modality to patients with benign renal diseases scheduled for elective nephrectomy with accepted rate of complication and conversion to open surgery.