UroToday- It was not until 9 years after the initial laparoscopic nephrectomy, that the first report on using this technique for xanthogranulomatous pyelonephritis (XGP) emerged from Washington University. At that time, we noted the procedures were much longer than the open, with no benefits in pain control or hospital stay, and were associated with a high rate of complications.

Over the years, has the laparoscopic approach to this condition improved? The answer is "a bit" but only "a bit". In this sobering report the authors compare 6 laparoscopic to 6 open nephrectomies for XGP. The procedure time was 2 hours longer in the laparoscopic group (p = 0.03). One of the 6 laparoscopic patients was converted to open and 2 cases were converted to hand-assist.
Complications were higher in the laparoscopic group (3 vs. 2).

Blood loss and hospital stay were not statistically significantly different between the two groups, but the former tended to be larger in the laparoscopic group (775 cc vs. 642 cc) while the latter tended to be shorter in the laparoscopic group (4.8 vs. 11 days). Analgesic use and ileus tended to be less in the laparoscopic group. The authors note that use of the harmonic shears and the hand-assist approach both seem to facilitate the procedure. However, even in the most experienced hands, whether open or laparoscopic, these nephrectomies, as a group, remain the most difficult of all.

B. A. Vanderbrink, M. C. Ost, A. Rastinehad, A. Anderson, G. H. Badlani, A. D. Smith, M. A. Levine, and B. R. Lee
Journal of Endourology 21(1): 65 - 70, January 2007

Reviewed by UroToday Medical Editor Ralph V. Clayman, MD

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