LAPAROSCOPIC NEPHROPEXY

Summary

Objective:
To present our contemporary technique of laparoscopic nephropexy. We follow data based on clinical studies of lower quality recommending the laparoscopic technique of suturing of renal capsule at convexity of kidney (1).

Material, methods: Indications for surgery are symptomatic patients with proven nephroptosis on radiological examinations (mainly IVU). From 12/2004 until 7/2016, nephropexy was performed on 31 women. In 28 on the right side, two times on both sides and once on left. The right side nephropexy was twice combined with dismembered pyeloplasty. The technique of surgery and results of pilot group were published already (2). The technique was modified in some aspects, mainly in the 10 last cases, barbed self-anchoring suture was used. The contemporary technique of the operation: Flank position, urinary catheter introduced. Pneumoperitoneum is created with Veres needle, pressure of CO₂ 12 mm Hg. Ten mm port for camera through umbilicus and further two working ports (5 and 3 mm). The peritoneum is opened in Toldt’s line. The lateral part of the kidney and the adjacent abdominal wall are cleaned. The kidney is fixed to the abdominal transversal muscle with three or four separate revolutions with long term absorbable/non-absorbable self-anchoring barbed stitch (V-Loc^® 180 or Non Absorbable, size 2-0, needle ½ 26 mm). The peritoneal defect is closed with a running barbed absorbable suture V-Loc^® 90. The stitches are introduced through trocar 10 mm and extracted through the same way or immediately through the abdominal wall with previous straightening of needle. No drain is placed. The patient is on bed-rest for three days. We recommend avoiding jumping, horse-riding etc. for two months.

Results:
Mean age was 36.4 ± 14.4 (20.0 to 65.1) years. Mean BMI 22.1 ± 2.8 (17.3 to 27.9). Mean time of operation on one side procedure 60.3 ± 17.1 (355 to 100), bilateral procedures (including rotation of patient) took 155 and 150 minutes. All procedures were without blood loss and peroperative and postoperative complications. Long-term results will be published later.

Conclusion:
Laparoscopic transperitoneal nephropexy with fixation of convexity of kidney with running self-anchoring barbed stitch is standard of surgical treatment of nephroptosis at our department. Meticulous dissection and careful liberation of the abdominal wall enabling safe suturing without damage of nerves of the abdominal wall is recommended. Due to relatively rarity of such surgery, long term results in a bigger group of patients will be only achievable in a multicentre trial.

KEY WORDS:
Nephropexy, laparoscopy.