LAPAROSCOPIC NEPHRECTOMY, RADICAL NEPHRECTOMY AND ADRENALECTOMY - NAGOYA EXPERIENCE

A total of 37 patients with various renal and adrenal diseases underwe nt laparoscopic nephrectomy, radical nephrectomy and adrenalectomy sin ce July 1991. The underlying diseases included renal calculi, vesicour eteral reflux, ureteropelvic junction obstruction, ureteral stenosis, ectopic ureter, vascular disease, renal cell carcinoma and adrenal tum ors. Twenty-nine kidneys (including 5 with renal cell carcinoma) and 5 adrenal glands were removed successfully. Three cases failed because of dense adhesion to the surrounding structures, hemorrhage from the r enal vein and hemorrhage fi om the vena cava, respectively. Of the rem aining 34 patients 3 required additional open laparotomy to control bl eeding or remove lost calculi. Mean operating time was 265 minutes for nephrectomy, 383 minutes for radical nephrectomy and 199 minutes for adrenalectomy, and mean estimated blood loss was 455 ml., 430 ml. and 80 ml., respectively. Average hospital stay was 10 days for the 31 pat ients without open laparotomy and convalescence was completed by posto perative day 21. These results indicate that laparoscopic surgery for renal and adrenal disease is a feasible, minimally invasive procedure. In the case of laparoscopic radical nephrectomy, however, longterm fo llowup is necessary to confirm the efficacy.