Simultaneous bilateral native nephrectomy by retroperitoneal approach

ABSTRACT The indication for simultaneous bilateral native nephrectomy and the choice of surgical technique is of key importance, as these patients are burdened with a large comorbidity. The paper reports our experience of seven successful and completed simultaneous bilateral native nephrectomy procedures with retroperitoneal approach in the patient’s flank position. Seven patients (mean age 34), were indicated for the removal of both kidneys before the planned transplant. Six patients underwent haemodialysis from 48 to 84 months, and one underwent peritoneal dialysis for 60 months. Two patients had undergone graftectomy. The indications were chronic infection or hypertension. The length of the kidneys ranged from 5.8 to 10cm. All procedures were performed by the laparoscopic technique with retroperitoneal approach, with the patient in the flank position. Three trocars were used on each side. The retroperitoneal space created did not require balloon dilatation. The kidneys were removed through the 10mm trocar hole after splitting. The duration of the procedure ranged from 150 to 240 minutes, average 139 minutes and blood loss ranged from100 to 250mL, average 142mL. There were no complications. In 6 patients, the postoperative dialysis was performed at zero-day. One patient continued peritoneal dialysis. Patients were discharged on the 2nd day, except one with peritoneal dialysis, who was discharged on the 3rd day. Retroperitoneal laparoscopic bilateral native nephrectomy is a safe and effective technique, and it can be considered as an ideal approach for native nephrectomy. It allows for the preservation of peritoneal integrity and vessels for future vascular access.摘要 同期双侧自体肾切除术（simultaneous bilateral native nephrectomy）的适应证与手术方式选择至关重要，此类患者往往合并多种合并症。本研究报道了7例采用侧卧位（flank position）腹膜后入路（retroperitoneal approach）腹腔镜手术成功完成同期双侧自体肾切除术的临床经验。 7例患者的平均年龄为34岁，均在拟行肾移植术前接受双侧肾脏切除。其中6例患者接受了48至84个月的血液透析（haemodialysis），1例患者接受了60个月的腹膜透析（peritoneal dialysis）。2例患者曾行移植肾切除术（graftnectomy）。本次手术的适应证为慢性感染或高血压。 患者的肾脏长度范围为5.8至10cm。所有手术均采用侧卧位腹膜后腹腔镜技术（laparoscopic technique）完成，每侧置入3个套管针（trocar），建立的腹膜后间隙无需行球囊扩张。肾脏经离断后通过10mm套管针切口取出。 手术时长为150至240分钟，平均139分钟；术中失血量为100至250mL，平均142mL。所有患者均未出现手术相关并发症。6例患者于术后当日开始透析，1例患者继续接受腹膜透析。除1例腹膜透析患者于术后第3日出院外，其余患者均于术后第2日出院。 腹膜后腹腔镜双侧自体肾切除术是一种安全有效的手术方式，可作为自体肾切除术的理想术式。该术式可保留腹膜完整性及血管结构，为后续血管通路建立预留条件。