Investig Clin Urol.  2019 May;60(3):210-215. 10.4111/icu.2019.60.3.210.

Laparoscopic transperitoneal heminephrectomy for treatment of the nonfunctioning moiety of duplex kidney in adults: A case series

• Singh M
• Agarwal S
• Goel A
• Kumar M
• Sharma A
• Pandey S
• Sankhwar S

• KMID: 2444276
• DOI: http://doi.org/10.4111/icu.2019.60.3.210

Abstract

PURPOSE
We report the results and experience of a tertiary care center in laparoscopic transperitoneal heminephrectomy for the treatment of a non-functioning upper pole moiety of duplex kidney in adults.
MATERIALS AND METHODS
The key point of the technique included the placement of a 6-Fr ureteric catheter in the healthy ureter at the beginning of the procedure under fluoroscopic guidance cystoscopically. A standard laparoscopic 3- to 4-port placement was done after placing the patient in a 45 to 90 degrees lateral decubitus position. The upper pole was mobilized transperitoneally and transected using a harmonic scalpel.
RESULTS
A total of 17 patients aged 19 to 44 years underwent laparoscopic upper pole heminephrectomy. All patients had a complete duplicated renal collecting system on the ipsilateral side. Three patients were found to have ureterocele. The average blood loss was minimal (50-150 mL) with a mean of 95 ml. None of the patients required any blood transfusions. The mean operative time was 220 minutes (range, 160-315 minutes). The average length of hospital stay was 3 days (range, 2-4 days). Only 2 patients had Clavien-Dindo grade 3a complications, which were managed by double J stenting and percutaneous aspiration, respectively.
CONCLUSIONS
Laparoscopic heminephrectomy is playing a cornerstone role in the treatment of the non-functioning moiety of duplex kidneys. The procedure is safe, efficient and offers the typical preoperative and postoperative benefits of laparoscopic surgery. The rate of complications in adults is acceptable and is similar to that reported in pediatric patients.

Keyword

Adult; Congenital abnormalities; Kidney; Laparoscopy

MeSH Terms

Adult*
Blood Transfusion
Catheters
Congenital Abnormalities
Humans
Kidney*
Laparoscopy
Length of Stay
Nephrectomy*
Operative Time
Stents
Tertiary Care Centers
Ureter
Ureterocele

Figure

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  Fig. 1 Bilateral duplex system with bilateral ureters entering the posterior surface of the bladder. Note the poorly functioning upper pole moiety on the right side.

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  Fig. 2 (A) Intraoperative view showing identification and dissection of the upper pole nonfunctioning moiety of the right kidney. (B) This patient had a double ureter draining the nonfunctioning upper pole. (C) The nonfunctioning upper pole with double ureter clipped and dissected for removal.

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