title: Simple Laparoscopic Nephrectomy in Stone Disease: Not Always Simple.
abstract: Simple nephrectomy is performed for a benign pathology that does not require the excision of either the adrenal gland or any adenopathies. When it is carried out in cases of stone disease, however, it is frequently not a "simple" technique owing to the presence of significant inflammation and infection.
  
  
  
  Ninety-six simple laparoscopic nephrectomies performed because of stone disease between 2006 and 2015 were retrospectively studied. A descriptive statistical analysis was performed, as well as an evaluation of the associated complications.
  
  
  
  Of the 96 laparoscopic nephrectomies (62 left, 34 right), 7 (7.2%) had to be converted into open surgery owing to the impossibility of dissecting the renal hilum because of xanthogranulomatous pyelonephritis (n = 4) or major associated lesions (n = 3). The indication for nephrectomy was lumbar pain associated with urinary infection, with a partial renal function below 15% assessed by DMSA renal scan. There were three major complications. Pathologic assessment revealed chronic pyelonephritis with kidney atrophy and associated pyonephrosis in 85 cases, xanthogranulomatous pyelonephritis in 10, and pT4 squamous cell carcinoma in 1.
  
  
  
  Despite its high technical difficulty, simple laparoscopic nephrectomy for stones is a viable technique for advanced laparoscopists. Its principal advantage compared with open surgery is improved postsurgical recovery, and it is associated with an acceptable complication rate. Xanthogranulomatous pyelonephritis is not an initial contraindication to laparoscopy, but it is the most significant risk factor for conversion to open surgery.
authors.affiliation: Urology Service, Fundació Puigvert , Barcelona, Spain .
authors.forename: Oriol
authors.initials: O
authors.lastname: Angerri
authors.affiliation: Urology Service, Fundació Puigvert , Barcelona, Spain .
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: López
authors.affiliation: Urology Service, Fundació Puigvert , Barcelona, Spain .
authors.forename: Francisco
authors.initials: F
authors.lastname: Sánchez-Martin
authors.affiliation: Urology Service, Fundació Puigvert , Barcelona, Spain .
authors.forename: Félix
authors.initials: F
authors.lastname: Millán-Rodriguez
authors.affiliation: Urology Service, Fundació Puigvert , Barcelona, Spain .
authors.forename: Antonio
authors.initials: A
authors.lastname: Rosales
authors.affiliation: Urology Service, Fundació Puigvert , Barcelona, Spain .
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000311:Adrenal Glands; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007249:Inflammation; D007668:Kidney / Q000601:surgery; D007669:Kidney Calculi / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D000072281:Lymphadenopathy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011705:Pyelonephritis, Xanthogranulomatous / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: kidney calculi; laparoscopic nephrectomy; xanthogranulomatous pyelonephritis