Prospective Evaluation of Preoperative Factors to Predict Intraoperative Difficulty during Transperitoneal Laparoscopic Simple Nephrectomy for Non-functioning Kidney Secondary to Urolithiasis
Baikuntha Adhikari *
Department of Urology, National Academy of Medical Scienes, Bir Hospital, Kathmandu, Nepal.
Parash Mani Shrestha
Department of Urology, National Academy of Medical Scienes, Bir Hospital, Kathmandu, Nepal.
Robin Bahadur Basnet
Department of Urology, National Academy of Medical Scienes, Bir Hospital, Kathmandu, Nepal.
Chitaranjan Shah
Department of Urology, National Academy of Medical Scienes, Bir Hospital, Kathmandu, Nepal.
Arvind Kumar Shah
Department of Urology, National Academy of Medical Scienes, Bir Hospital, Kathmandu, Nepal.
*Author to whom correspondence should be addressed.
Abstract
Background: Laparoscopic simple nephrectomy (LSN) for non-functioning kidney (NFK) due to urolithiasis is considered difficult with higher conversions to open surgery and complication rates than radical nephrectomy. Preoperative assessment of operative difficulty would be useful for optimal preoperative planning, to select patients with less difficulty in early phases of learning and to counsel patients. There is a paucity of the prospective studies assessing intraoperative difficulty during LSN for stone related NFK.
Objectives: To evaluate preoperative clinical and radiological characteristics that could predict difficulty during transperitoneal LSN for NFK due to urolithiasis.
Methods: A prospective study was done in National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal from September 2021 to August 2022 among patients undergoing transperitoneal LSN for NFK secondary to urolithiasis. Demographic and clinico-radiological parameters were documented preoperatively. A single experienced surgeon provided the difficulty score for major steps of surgery in a Likert scale of 1(easy) to 4 (most difficult). Final difficulty scale was calculated adding blood loss and operative duration as surrogate markers of difficulty. Patients were divided into two groups, Easy group, and Difficult group based on difficulty scale. Preoperative, intraoperative, and postoperative characteristics were compared between the groups. Univariate and multivariate analysis was done to identify factors that could predict intraoperative difficulty.
Results: There were 88 patients included in the final analysis. Presence of pyonephrosis (p<0.001) and preoperative percutaneous nephrostomy (p=0.04) showed significant correlation with intraoperative difficulty in univariate analysis. However, pyonephrosis was only significantly associated with difficulty during multivariate analysis (OR 3.87, 95% CI 1.00-14.96). Patients with pyonephrosis had higher conversion rates to open surgery and higher complication rates.
Conclusions: Pyonephrosis in NFK secondary to urolithiasis predicted higher intraoperative difficulty during LSN. Patients with pyonephrosis experienced higher conversions to open surgery and higher complications rate.
Keywords: Urolithiasis, difficulty, laparoscopic nephrectomy, non-functioning kidney, pyonephrosis
How to Cite
References
Shrestha A, Chhettri P, Yadav BK, Basnet RB, Shrestha PM. Urinary stone disease and preventable nephrectomies. J Nepal Health Res Counc. 2019;17:238-241. DOI:10.33314/jnhrc.v0i0.1996
Akmal M, Mirza ZI, Murtaza B. Are we performing a lot of simple nephrectomies?. J Pak Med Assoc. 2017;67:438-441.
Available:https://jpma.org.pk/article-details/8124
Burgess NA, Koo BC, Calvert RC, Hindmarsh A, Donaldson PJ, Rhodes M. Randomized trial of laparoscopic v open nephrectomy. J Endourol. 2007;21:610-613.
DOI:10.1089/end.2006.0277
Zelhof B, McIntyre IG, Fowler SM, et al. Nephrectomy for benign disease in the UK: results from the British Association of Urological Surgeons nephrectomy database. BJU Int. 2016;117:138-144.
DOI:10.1111/bju.13141
Keshavamurthy R, Gupta A, Manohar CS, Karthikeyan VS, Singh VK: Is simple nephrectomy the right nomenclature? - comparing simple and radical nephrectomy to find the answer. J Family Med Prim Care. 2022;11:1059-1062.
DOI:10.4103/jfmpc.jfmpc_1014_21
Angerri O, Lopez JM, Sanchez-Martin F, Millan-Rodriguez F, Rosales A, Villavicencio H. Simple Laparoscopic nephrectomy in stone disease: Not always simple. J Endourol. 2016;30:1095-1098.
DOI:10.1089/end.2016.0281
Atik YT, Cimen HI, Gul D, Uysal B, Köse O, Halis F: The simple nephrectomy is not always Simple: predictors ofsSurgical difficulties. Uro Int. 2022;106:553-559.
DOI:10.1159/000521394
Cueto-Vega GJ, Basulto-Martinez MJ, Esqueda-Mendoza A, et al.: Laparoscopic nephrectomy in patients with renal exclusion secondary to urolithiasis. Which factors can predispose conversion to open surgery? Cir Cir. 2022;90:454-458.
DOI:10.24875/CIRU.20001397
Gahlawat S, Sood R, Sharma U, et al. Can preoperative clinicoradiological parameters predict the difficulty during laparoscopic retroperitoneal simple nephrectomy? - A prospective study. Urol Ann. 2018;10:191-197.
DOI:10.4103/ua.Ua_141_17
Ratner LE, Smith P, Montgomery RA, Mandal AK, Fabrizio M, Kavoussi LR. Laparoscopic live donor nephrectomy: pre-operative assessment of technical difficulty. Clin Transplant. 2000; 14:427-432.
DOI:10.1034/j.1399-0012.2000.1404120 2.x
Shah P, Ganpule A, Mishra S, Sabnis R, Desai MR. Prospective study of preoperative factors predicting intraoperative difficulty during laparoscopic transperitoneal simple nephrectomy. Urol Ann. 2015;7:448- 453.
DOI:10.4103/0974-7796.152045
Ganpule AP, Gotov E, Mishra S, Muthu V, Sabnis R, Desai M. Novel cost-effective specimen retrieval bag in laparoscopy: Nadiad bag. Urology. 2010;75:1213-1216. DOI:10.1016/j.urology.2008.09.057
Sammon J, Trinh QD, Sun M, et al. The effect of gender on nephrectomy perioperative outcomes: a national survey. Can J Urol. 2012;19:6337-6344. Available:https://www.canjurol.com/abstract.php?ArticleID=&version=1.0&PMID=22892256
Hsiao W, Pattaras JG. Not so "simple" laparoscopic nephrectomy: outcomes and complications of a 7-year experience. J Endourol. 2008;22:2285-2290.
DOI:10.1089/end.2008.9718
Matin SF, Abreu S, Ramani A, et al. Evaluation of age and comorbidity as risk factors after laparoscopic urological surgery. J Urol. 2003;170: 1115-1120. DOI:10.1097/01.ju.0000086091.64755.ac
Naya Y, Tobe T, Suyama T, et al. The efficacy and safety of laparoscopic nephrectomy in patients with three or more comorbidities. Int J Urol. 2007;14:17-20.
DOI:10.1111/j.1442-2042.2006.01663.x
Permpongkosol S, Link RE, Su L-M, et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol. 2007;177:580-585.
DOI:10.1016/j.juro.2006.09.031
Danilovic A, Ferreira TAC, Maia GVA, et al.Predictors of surgical complications of nephrectomy for urolithiasis. Int Braz J Urol. 2019;45:100-107.
DOI:10.1590/S1677-5538.IBJU.2018.0246
Lafranca JA, Hagen SM, Dols LF, et al. Systematic review and meta-analysis of the relation between body mass index and short-term donor outcome of laparoscopic donor nephrectomy. Kidney Int. 2013;83: 931- 11 of 12 939.
DOI:10.1038/ki.2012.485
Anast JW, Stoller ML, Meng MV, et al. Differences in complications and outcomes for obese patients undergoing laparoscopic radical, partial or simple nephrectomy. J Urol. 2004; 172:2287-2291.
DOI:10.1097/01.ju.0000143820.56649.a4 https://escholarship.org/uc/item/0dv75512
Manohar T, Desai M, Desai M. Laparoscopic nephrectomy for benign and inflammatory conditions. J Endourol. 2007; 21:1323-1328.
DOI:10.1089/end.2007.9883
Ouellet S, Sabbagh R, Jeldres C. Transperitoneal laparoscopic nephrectomy: Assessing complication risk in cases of previous abdominal surgery. Can Urol Assoc J. 2017;11:131-135. DOI:10.5489/cuaj.4107
Aminsharifi A, Goshtasbi B. Laparoscopic simple nephrectomy after previous ipsilateral open versus percutaneous renal surgery. JSLS. 2012;16:592-596. DOI:10.4293/108680812x13462882737212
Parsons JK, Jarrett TJ, Chow GK, Kavoussi LR. The effect of previous abdominal surgery on urological laparoscopy. J Urol. 2002;168:2387-2390.
DOI:10.1016/S0022-5347(05)64151-1
Abou-Elela A, Ghonaimy M, Reyad I, Abdelrazak O, Bedair AS. Outcome and complications of laparoscopic nephrectomy in patients with previous renal surgery. J Laparoendosc Adv Surg Tech A. 2008;18: 237-243.
DOI:10.1089/lap.2007.0060
Seifman BD, Dunn RL, Wolf Jr JS. Transperitoneal laparoscopy into the previously operated abdomen: effect on operative time, length of stay and complications. J Urol. 2003;169:36-40. DOI:10.1016/S0022-5347(05)64029-3
Turna B, Aron M, Frota R, Desai MM, Kaouk J, Gill IS. Feasibility of laparoscopic partial nephrectomy after previous ipsilateral renal procedures. Urology. 2008; 72:584-588. DOI:10.1016/j.urology.2008.04.002
Binsaleh S, Luke PP, Nguan C, Kapoor A. Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: Operative challenges and technique. Can J Urol. 2006; 13:3340-3345.
Available;https://europepmc.org/article/med/17187698
Challacombe B, Sahai A, Murphy D, Dasgupta P. Laparoscopic retroperitoneal nephrectomy for giant hydronephrosis: When simple nephrectomy isn't simple. J Endourol.2007;21:437-440. DOI:10.1089/end.2006.0246
Yucel C, Ulker V, Kisa E, Koc G, Ilbey YO. Laparoscopic transperitoneal nephrectomy in non-functioning severe hydronephrotic kidneys with or without renal stone. Cureus.2018;10:3729. DOI:10.7759/cureus.3729
Gulpinar MT, Akcay M, Sancak EB, et al. Comparison of transperitoneal laparoscopic nephrectomy outcomes in atrophic and hydronephrotic kidneys. Turk J Urol. 2015,41:181-184. 10.5152/tud.2015.97523
Adiga P, Jain M, Srinidhi R. Impact of nephrostomy in patients undergoing nephrectomy for calculus disease international journal of scientific research. Int J Sci Res. 2020;9:52-54.
DOI:10.36106/ijsr
Kapoor R, Vijjan V, Singh K, et al. Is laparoscopic nephrectomy the preferred approach in xanthogranulomatous pyelonephritis?. Urology. 2006;68:952-955. DOI:10.1016/j.urology.2006.07.009
Yıldız G, Kılıç Ö, Batur AF, Akand M: Challenges in laparoscopic simple nephrectomy of non-functioning kidneys due to urolithiasis. J Urol Surg. 2021;8(1): 54-58.
DOI:10.4274/jus.galenos.2021.0028