Laparoskopik basit nefrektomi: İlk deneyimlerimiz

Year 2012, Volume: 7 Issue: 1, 11 - 14, 01.01.2012

İlhan Geçit Necip Pirinççi Mustafa Güneş Serhat Tanık Kerem Taken Recep Eryılmaz Kadir Ceylan

Abstract

Amaç: Kliniğimizde yapılan ilk laparoskopik basit nefrektomi vakalarını retrospektif olarak incelemek.Gereç ve Yöntem: Haziran 2010- Temmuz 2011 yılları arasında, toplam 12 hastaya transperitoneal laparoskopik basit nefrektomi yapıldı. Operasyon zamanı, kan kaybı, hastanede kalış ve takip süreleri, peroperatif ve postoperatif komplikasyonlar açısından incelendi.Bulgular: Hastaların 5’i %41.7 kadın, 7’si %58.3 erkek idi. Yaşları 12 ile 72 arasında ortalama 48 yaş idi. Dört %33.3 hastada sağ, 8 %66.6 hastada sol renal hastalık mevcuttu. Dört %33.3 hastada atrofik böbrek, 6 %50 hastada taşa sekonder nonfoksiyone hidronefrotik böbrek, 1 %8.3 hastada multikistik displastik böbrek, 1 %8.3 hastada ise vezikoüreteral reflüye bağlı nonfonksiyone böbrek mevcuttu. Ameliyat sırasında hiçbir hastaya kan transfüzyonu yapılmadı, ancak bir hastada kontrol edilemeyen kanama sebebiyle açık cerrahiye geçildi. Postoperatif herhangi bir komplikasyon gözlenmedi. Ameliyat süresi ortalama 100dk 80–160 dk idi. Hastaların hastanede kalış süreleri ise ortalama 3.2gün 2–6 gün idi. Ortalama takip süresi 6.8 ay idi.Sonuç: Laparoskopik nefrektomi hastalar tarafında daha iyi tolere edilmesi, daha az hastanede kalış süresi, daha az postoperatif ağrı kesici ihtiyacı ve daha iyi kozmetik sonuçları ile tercih edilir bir tedavi yöntemidir

Keywords

Laparoskopi , transperitoneal , nefrektomi

Laparoscopic simple nephrectomy: Our ınitial experiences

Abstract

Objective: To retrospectively examine the initial cases undergoing laparoscopic simple nephrectomy in our Department.Material and Methods: Transperitoneal laparoscopic simple nephrectomy was performed in 12 patients between June 2010 and July 2011. Operation time, blood loss, the duration of the hospital stay and the follow-up, peroperative and postoperative complications were analyzed.Results: Of the patients, 5 41.7% were female and 7 58.3% were male. Their ages were between 12 and 72 mean 48 years . The renal pathology was on the right side in four patients 33.3% and the left side in eight patients 66.6% . There were atrophic kidney in 4 patients 33.3% , non-functioning hydronephrotic kidney secondary to stone disease in 6 patients 50% , multicystic dysplastic kidney in 1 patient 8.3% , and non-functioning kidney related to the vesicoureteral reflux in 1 patient 8.3% . No blood transfusion was performed in patients during the surgery, but it was converted to the open surgery in a patient because of uncontrollable bleeding. No postoperative complication was observed. The average duration of the operation was 100min 80-160 min . Average hospital stay was 3.2 days 2-6 days . Average length of follow-up was 6.8 months.Conclusion: Laparoscopic nephrectomy is a preferable method of treatment with the better toleration by the patients, the shorter hospital stay, the less postoperative pain relief and the more favourable cosmetic results

Keywords

Laparoscopy , transperitoneal , nephrectomy

References

• Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thomson PG, Long SR. Laparoscopic nephrectomy: Initial case report. J Urol. 1991;146(2):278-282.
• Winfield HN, Donovan JF, Godet AS, Clayman RV. Lapa- roscopic partial nephrectomy: Initial case report for be- nign disease. J Endourol 1993;7: 521-526.
• Gaur DD, Agarwal DK, Purohit KC. Retroperitone- al laparoscopic nephrectomy:Initial case report. J Urol 1993;149:103–105. J Urol 1991;146:278-282.
• Ehrlich R, Gershman A, Fuchs G. Laparoscopic renal sur- gery in children. J Urol 1994;151:735-739.
• McDougall EM, Clayman RV. Laparoscopic nephrectomy and nephroureterectomy in the octogenarian with a renal tumour. J Laparoendosc Surg 1994;4: 233-236.
• Fornara P, Doehn C, Fricke L, Hoyer J, Jocham D. Lapa- roscopy in renal transplant patients. Urology 1997;49: 521- 527.
• Gill IS. Laparoscopic radical nephrectomy for cancer. Urol Clin North Am. 2000, 27: 707-719.
• Kerbl K, Clayman RV, McDougall EM, Gill IS, Wilson BS, Chandhoke PS, Albala DM, Kavoussi LR. Transperitone- al nephrectomy for benign disease of the kidney: A com- parison of laparoscopic and open surgical techniques. Uro- logy 1994;43: 607-613.
• Parra RO, Perez MG, Boullier JA, Cummings JM. Compa- rison between standard flank versus laparoscopic nephrec- tomy for benign renal disease. J Urol 1995;153:1171-1174.
• Doublet JD, Barreto HS, Degremont AC, Gategno B, Thi- bault P: Retroperitoneal nephrec-tomy. Comparison of la- paroscopy with open surgery. World J Surg 1996;20: 713- 716.
• Doehn C, Fornara P, Fricke L, Jocham D. Comparison of laparoscopic and open nephroureterectomy for benign di- sease. J Urol 1998;159:732-734.
• Gundetti MS, Patel Y, Duffy PG et al. An initial experience of 100 pediatric laparoscopic nephrectomies with transpe- ritoneal laparoscopic or posterior prone retroperitoneos- copic approach. Pediatr Surg Int 2007; 23: 795-799
• Kural AR. Laparoskopik radikal nefrektomi. Üroonkoloji Bülteni 2003; 3: 9-16
• Leclair MD, Vidal I, Suply E et al. Retroperitoneal laparos- copic heminephrectomy in duplex kidney in infants and children: a 15 -year experience. Eur urol 2008; 2641: 1-7
• McDougall EM, Clayman RV, Erashry OM. Laparoscopic radical nephrectomy for renal tumors: The Washington University experience. J. Urol 1996; 155:1180
• Kim C, McKay K, Docimo S. Laparoscopic nephrectomy in children: systemic review of transperitoneal laparosco- pic and retroperitoneal approaches. Urology 2009;73: 280- 284
• Gill IS, Kavoussi LR, Clayman RV, Ehrlich R, Evans R, Fuchs G, Gersham A, Hulbert JC, McDougall EM, Ro- senthal T, Schuessler WW, Shepard T. Complications of laparoscopic nephrectomy in 185 patients: A multi- institutional review. J Urol 1995;154: 479-483.
• Keeley FX, Tolley DA. A review of our first 100 cases of la- paroscopic nephrectomy: Defining risk factors for compli- cations. Br J Urol 1998;82: 615-618.
• Siqueira TM, Kuo RL, Gardner TA, Paterson RF, Stevens LH, Lingeman JE, Koch MO, Shalhav AL. Major complica- tions in 213 lapa-roscopic nephrectomy cases: The India- nopolis experience. J Urol 2002;168:1361
• Kural AR, Demirkesen O, Akpınar H, Tüfek İ, Yalçın V, Özkan B. Laparoskopik Nefrektomide Başlangıç Deneyim- lerimiz. Our İnıtıal Experıences wıth Laparoscopıc Neph- rectomy Türk Üroloji Dergisi 2004; 30: 414-421
• Toktaş G, Ünlüer E, Erkan E, Küçükpolat S, Demiray M, Toker A. Laparoskopik Böbrek Cerrahisinde Öğrenme Sü- reci ve Bunu Etkileyen Faktörler. Learning Curve in Lapa- roscopic Renal Surgery and Influencing Factors. İstanbul Tıp Derg - Istanbul Med J 2011;12: 1-4
• Binbay M, Yazıcı Ö, Kaba M, Berberoğlu Y, Müslümanoğ- lu AY, Tefekli AH. Ürolojide laparoskopik girişimlerle il- gili istenmeyen yan etkiler:313 girişimin değerlendirilme- si. Complications associated with urological laparoscopic procedures: an analysis of 313 cases. Türk Üroloji Dergi- si - Turkish Journal of Urology. 2009;35: 17-22
• Gomella LG, Abdel-Meguid TA, Lotfi MA, Hirsch IH, Al- bala D, Manyak M, et al. Laparoscopic urologic surgery outcome assessment. J Laparoendosc Adv Surg Tech A 1997;7: 77-86
• Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA. Complications of laparoscopic procedures in urology: experience with 2407 procedures at 4 German centers. J Urol 1999;162: 765-770
• Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, et al. Complications of 2775 urological lapa- roscopic procedures: 1993 to 2005. J Urol 2007;177:580- 585
• Rassweiler J, Fornara P, Weber M, Janetschek G, Fahlen- kamp D, Henkel T, Beer M, Stackl W, Boeckmann W, Rec- ker F, Lampel A, Fischer C, Humke U, Miller K. Lapa- roscopic nephrectomy: The experience of the laparoscopy working group of the German UrologicalAssociation. J Urol 1998;160: 18-21.
• Eraky I, El-Kappany HA, Ghonheim MA. Laparoscopic nephrectomy: Mansoura experience with 106 cases. Br J Urol 1995;75: 271-275.