Perioperative Complications in Patients Undergoing Simultaneous Bilateral Lumboscopic Nephrectomy

TL;DR

This study examines the safety and complication rates of a specific surgical technique used in kidney transplant candidates.

Contribution

The study provides insights into the safety profile of a rarely documented surgical approach for bilateral nephrectomy.

Findings

The procedure had an acceptable rate of major complications with no vascular or visceral injuries.

Six patients successfully proceeded to renal transplantation following the surgery.

Abstract

Background and aim: Bilateral nephrectomy is necessary to optimize the condition of patients undergoing renal transplantation. Our simultaneous lumboscopic technique is scarcely documented but may offer benefits for patients with end-stage renal disease in the transplant protocol. This study aimed to identify major postoperative complications associated with this approach.
This study aims to determine the frequency and characteristics of postoperative complications of grade ≥3, according to the Clavien-Dindo classification, in patients undergoing simultaneous bilateral lumboscopic nephrectomy.

Methodology: A retrospective cohort study was conducted on patients undergoing simultaneous bilateral lumboscopic nephrectomy with left nephroureterectomy and endoscopic bladder cuff excision, between January 2015 and February 2024. Clinical and surgical variables, major complications, and transfusion requirements were analyzed.

Results: Seventeen patients were included, with a mean age of 42.2 years and a female predominance (11, 64.7%). All were on renal replacement therapy. The most frequent indication was recurrent urinary tract infections associated with vesicoureteral reflux (11, 64.7%). The mean operative time was 228.2 minutes, with an average blood loss of 141.7 mL. According to the Clavien-Dindo classification, two grade III, two grade II, and three grade I complications were reported. Postoperative transfusions were required in 6 (35.3%) patients. No vascular or visceral complications occurred. Six patients successfully underwent renal transplantation.
Conclusions: Simultaneous bilateral lumboscopic nephrectomy, including nephroureterectomy with bladder cuff excision, is a safe and feasible technique in renal transplant candidates, with an acceptable rate of major complications and preservation of the previous dialysis modality.