LAPAROSCOPIC NEPHRECTOMY - THE EXPERIENCE OF THE LAPAROSCOPY WORKING GROUP OF THE GERMAN-UROLOGIC-ASSOCIATION

Purpose: The centers of the laparoscopy working group of the German Ur ologic Association collected data to prove the efficacy, safety and re producibility of laparoscopic nephrectomy. Materials and Methods: At 1 4 centers 482 laparoscopic nephrectomies have been performed until Dec ember 1996 via a transperitoneal approach in 344 (71%) and a retroperi toneal approach in 138 (29%). All 482 laparoscopic nephrectomies were performed by a total of 20 surgeons with an average of 24 procedures p er surgeon (range 4 to 105). The indications for nephrectomy were beni gn renal pathology in 444 patients (92%), including renovascular disea se in 28%, hydronephrosis in 20%, reflux nephropathy in 15%, chronic p yelonephritis in 12%, end stage nephrolithiasis in 11%, renal dysplasi a in 4% and renal tuberculosis in 1%. Of the remaining 38 patients (8% ) laparoscopic radical nephrectomy was performed for renal cell carcin oma in 5% and for upper tract transitional cell carcinoma in 3%. Resul ts: Operating time depended mainly on the pathology of the kidney (tha t is small dysplastic organ versus large hydronephrosis) and the learn ing curve of the surgeon. However, the average operating time did not vary significantly among the different centers (maximum 277.6 and mini mum 81.9 minutes). Intraoperative or perioperative complications were noted in 29 patients (6.0%), including bleeding in 22 (4.6%), bowel in jury in 3, hypercarbia in 2 and pleura lesion in 1 and pulmonary embol ism in 1. The conversion rate was 10.3% (bleeding, bowel injury, diffi cult dissection), including 4 patients with renal tuberculosis, 2 with xanthogranulomatous nephritis, and 1 each following renal trauma and embolization. The re-intervention rate was 3.4% due to bleeding in 6 c ases, abscess formation in 3, intestinal stenosis in 2 and a pancreati c fistula and port hernia in 1. Mean hospital stay was 5.4 days. Concl usions: Laparoscopic nephrectomy has become a well established procedu re in those urology departments focusing on laparoscopy. The indicatio ns and results are reproducible at these centers. However, for patient s with severe perinephritis (that is renal tuberculosis, xanthogranulo matous nephritis, posttraumatic atrophy) a higher likelihood of open c onversion must be considered.