Bilateral purely laparoscopic nephrectomy for renal masses using five ports without repositioning: a case report.
OBJECTIVE
Bilateral nephrectomy is an infrequently performed procedure. The indications include bilateral masses too large for nephron-sparing surgery, recalcitrant hypertension in dialysis patients, pain, infection, reflux, or large symptomatic polycystic kidneys. Bilateral pretransplant purely laparoscopic nephrectomy for bilateral renal masses has not been reported previously. We present our experience with this procedure using five transabdominal trocars without having to reposition the patient.


METHODS
We employed a five-port technique in a middle-aged woman with end-stage renal disease who presented with an infected peritoneal dialysis catheter. On abdominal CT, she had bilateral enhancing renal masses. Six weeks after removal of the catheter, she underwent bilateral transperitoneal laparoscopic nephrectomy. The technique is described, and recommendations are made regarding potential obstacles.


RESULTS
The procedure was performed in 185 minutes, and the total hospital time was 41 hours. The estimated blood loss was 50 mL. Final pathology examination revealed a 5.5-cm right renal-cell carcinoma stage T1N0M0 and left hydronephrosis, atrophy, nephrosclerosis, and thick-walled renal cysts without malignancy. On 3-month follow-up she is well, without complaints.


CONCLUSIONS
Bilateral pretransplant purely laparoscopic nephrectomy can be performed without significant repositioning, redraping, and resterilization. In this case, operative time and cosmesis were acceptable, and surgical morbidity was low.
Schwartz
Bradley F
BF
Department of Urology and Center of Laparoscopy and Endourology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9665, USA. bschwartz@siumed.edu
Vestal
James C
JC
D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*