Comparison of retroperitoneoscopic nephrectomy with open surgery for tuberculous nonfunctioning kidneys

Purpose: We describe, define and evaluate the role of retroperitoneoscopic nephrectomy for tuberculous nonfunctioning kidneys, and compare the results with those of open nephrectomy in similar cases in a nonrandomized study. Materials and Methods: Beginning in July 1994, 9 patients underwent retrope ritoneoscopic nephrectomy for tuberculous nonfunctioning kidneys at our cen ter. Data obtained from the records of these patients were compared with th ose of 9 who underwent open nephrectomy for a similar indication during the same period. Retroperitoneoscopic nephrectomy was initially performed by k idney dissection followed by ligation of the hilar vessels. The technique w as subsequently modified and the vessels controlled before dissecting the k idney. Various parameters were compared and statistical analysis was done. Results: The 2 groups were similar in regard to patient age, gender and sid e of disease. Retroperitoneoscopic nephrectomy was successful in 7 of the 9 patients. Although 2 of our initial patients required conversion to open s urgery, the remaining 7 successfully underwent retroperitoneoscopic nephrec tomy after modifying the technique. Mean operative time was slightly greate r in the retroperitoneoscopy than in the open surgery group (103.3 versus 9 2.2 minutes). Mean blood loss was less in the retroperitoneoscopy group (10 1.4 versus 123.3 mi.), mean hospital stay plus or minus standard deviation was significantly shorter (3.2 +/- 0.83 versus 8.88 +/- 3.37 days) and mean time to return to work was significantly less (3 versus 7 weeks). Mean ana lgesic requirement for opioids and diclofenac sodium was also lower in the retroperitoneoscopic nephrectomy group (0 versus 1.44 +/- 0.72 and 3.8 +/- 1.3 versus 4.3 +/- 1.2 doses, respectively). Minor complications developed in only 2 retroperitoneoscopy cases. Conclusions: Tuberculosis has been considered a contraindication to retrope ritoneoscopic nephrectomy due to a high conversion rate. However, we believ e that our modified technique of retroperitoneoscopic nephrectomy is a viab le option for managing tuberculous nonfunctioning kidneys. The conversion r ate is lower than previously reported. Comparing our results with those of open nephrectomy shows that retroperitoneoscopic nephrectomy is beneficial in all respects except for slightly longer operative time. Because of the b enefits of minimally invasive surgery, this approach should be considered i n such cases.