Laparoscopic nephrectomy in patients undergoing hemodialysis treatment

Background and Objectives: To report our experience with laparoscopic nephrectomy (LN) in patients undergoing hemodialysis compared with normal counterparts. Methods: Seventeen patients (20 renal units, Group 1) undergoing hemodialysis underwent LN, which was indicated due to nonfunctioning kidney in 17 and suspected malignancy in 3 renal units. Radical nephrectomy (RN), simple nephrectomy (SN), and simple nephroureterectomy (SNU) were performed in 3, 9, and 8 cases, respectively. For comparison, 101 patients (Group 2) without CRF (chronic renal failure) who had undergone LN were evaluated. In this group, RN, SN, SNU and radical nephroureterectomy (RNU) were performed in 48, 41, 8, and 4 patients, respectively. Results: The mean age (36.9±13.1 vs. 48.7±19.4yr, P=0.002) and BMI (22.1±4.8 vs. 26.2±5.1kg/m², P=0.001) were lower in Group 1, whereas ASA (physical status score of American Society of Anesthesiologists) score (2.8±0.4 vs. 1.5±0.7, P<0.001) was lower in Group 2. The estimated blood loss (111±114 vs. 184±335mL, P=0.34) was higher in Group 2. Both groups were comparable in regard to mean operative time (133±79 vs. 119±45, P=0.70), hematocrit drop (4.69±3.9 vs. 3.86±3.0, P=0.29) and hospital stay (3.6±3.3 vs. 3.3±2.4 days, P=0.34). Meanwhile, when only patients undergoing SN and SNU in the study cohort (n=17 in Group 1 and n=49 in Group 2) are taken into consideration, no significant difference was observed between the 2 groups in terms of any kind of above-mentioned perioperative parameters. No case in Group 1 was converted to open surgery due to metabolic problems. Conclusions: LN in patients undergoing hemodialysis may be performed safely by an experienced laparoscopy team.