title: Retroperitoneal laparoscopic nephrectomy for acute blunt grade 4 renal injuries.
abstract: OBJECTIVE
  To first describe laparoscopic nephrectomy (LN) for patients with acute blunt Grade 4 renal injuries using a retroperitoneal approach.
  
  
  METHODS
  Three patients (2 males and 1 female) with acute blunt renal trauma underwent retroperitoneal LN successfully. The revised American Association for Surgery of Trauma grading system was used to grade renal injuries. All three patients with Grade 4 renal injuries required blood transfusions preoperatively and angiographic embolization because of hemodynamic instability. Given the severity of the renal injuries, failure of angiographic embolization, and persistent blood loss, surgical intervention was used. We performed retroperitoneal LN using four trocars within 24 hours after trauma for the patients.
  
  
  RESULTS
  Pure retroperitoneal LN was successfully performed in all 3 patients without requiring hand-assisted or open surgery. The renal hematoma dimension for the patients was 7.5, 8.4, and 9.2 cm, respectively. Operative time was 80, 110, and 130 minutes, respectively. Estimated blood loss was 100, 140, and 300 mL, respectively. The incision size was 4.2, 4.2, and 4.5 cm, respectively. The average hospital stay was 6 days. Pathology showed renal injuries without incidental renal tumors.
  
  
  CONCLUSIONS
  Despite the technical challenges, LN for patients with acute blunt Grade 4 renal injuries using a retroperitoneal approach is safe and feasible in carefully selected patients if conservative measures and angiographic embolization fail. However, it is important to note that one should keep a low threshold for open conversion or the hand-assisted approach whenever necessary.
authors.affiliation: 1 Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China .
authors.forename: Wenying
authors.initials: W
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xu
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Adams
authors.forename: Ye
authors.initials: Y
authors.lastname: Tian
mesh_terms: D058186:Acute Kidney Injury / Q000601:surgery*; D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D006406:Hematoma; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000293:injuries* / Q000601:surgery; D007674:Kidney Diseases / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D012187:Retroperitoneal Space / Q000601:surgery; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult