title: Retroperitoneoscopic nephrectomy in dialysis dependent patients and comparison with open surgery.
abstract: OBJECTIVE
  To evaluate the surgical outcomes and morbidity of retroperitoneoscopic nephrectomy compared with open nephrectomy for dialysis dependent patients.
  
  
  METHODS
  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 +/- 84 min, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sittm@mahidol.ac.th
authors.forename: Tawatchai
authors.initials: T
authors.lastname: Taweemonkongsap
authors.forename: Chaiyong
authors.initials: C
authors.lastname: Nualyong
authors.forename: Teerapon
authors.initials: T
authors.lastname: Amornvesukit
authors.forename: Sittiporn
authors.initials: S
authors.lastname: Srinualnad
authors.forename: Phichaya
authors.initials: P
authors.lastname: Sujijantararat
authors.forename: Suchai
authors.initials: S
authors.lastname: Soontrapa
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery* / Q000628:therapy; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D011184:Postoperative Period; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D055815:Young Adult