ORIGINAL RESEARCH

Urology

doi: 10.25005/2074-0581-2024-26-2-244-253
A SURGICAL DECISION-MAKING FRAMEWORK FOR OPTIMAL APPROACHES TO NEPHRECTOMY

A.YU. ODILOV1,2,3, Z.A. KADYROV1, F.S. SADULLOEV2

1Department of Endoscopic Urology and Ultrasound Diagnostics, Faculty of Continuing Medical Education, Medical Institute, Patrice Lumumba Peoples' Friendship University of Russia, Moscow, Russian Federation
2Department of Urology, Tajik State Medical University Abuali ibni Sino, Dushanbe, Republic of Tajikistan
3Republican Scientific and Clinical Center for Urology, Dushanbe, Republic of Tajikistan

Objective: To determine the optimal surgical approach when performing nephrectomy by assessing the main intra- and postoperative indicators of various operative surgical technique types of nephrectomy.

Methods: A total of 803 patients underwent examination and surgery for various conditions accompanied by renal failure, such as urolithiasis, pyonephrosis, pyelonephritis, obstructive uropathy with nephrosclerosis, and large or difficult-to-reach kidney tumors. A conventional open nephrectomy (ON) and laparoscopic nephrectomy (LN) using various as well as retroperitoneoscopic nephrectomy (RN) were performed in 368, 269, and 166 cases, respectively

Results: The average duration of LN, RN, and ON was 140.0 minutes (range 40-420 minutes), 120.0 minutes (range 40-220 minutes), and 95.0 minutes (range 35-290 minutes), respectively (p<0.001). The proposed tactics using retroperitoneoscopic access helped to reduce the average operation time by 32.23 minutes. In patients with a history of lumbar surgery, laparoscopic access reduced operation time by 1.2 times (23.20 minutes). In large tumors in the anterior segment that have invaded the renal sinus, using RN reduced operation time by 23.01 minutes. Similarly, in tumors in the posterior segment that have invaded the sinus, using LN reduced operation time by 23.40 minutes. Our improved one-stage nephrectomy method for pyonephrosis has reduced the length of hospital stay compared to the two-stage method. We recorded statistically significant differences in the number of blood transfusions, length of stay in intensive care, usage of analgesics (both narcotic and non-narcotic), and number of days of postoperative stays for ON and videoendoscopic nephrectomy methods.

Conclusion: Our findings suggest implementing a case-based surgical approach during nephrectomy is feasible and effective. The choice of access should be made based on the specific clinical situation. Despite the long duration of the operation, videoendoscopic methods have clear advantages over conventional ones in terms of such parameters as the volume of blood loss, postoperative analgesia, length of stay in the intensive care unit, and hospital stay overall.

Keywords: Traditional nephrectomy, laparoscopic nephrectomy, retroperitoneoscopic nephrectomy, duration of operation, intraoperative and postoperative indicators.

Download file:


References
  1. Kadyrov ZA. Laparoskopicheskie i retroperitoneoskopicheskie operatsii v urologii [Laparoscopic and retroperitoneoscopic operations in urology]. Moscow, RF: GEOTAR-Media; 2017. 488 p
  2. Kadyrov ZA, Odilov AYu. Oslozhneniya traditsionnoy, laparoskopicheskoy i retroperitoneoskopicheskoy nefrektomii pri razlichnykh zabolevaniyakh pochek [Complications of traditional, laparoscopic and retroperitoneoscopic nephrectomy for various kidney diseases]. Urologiya. 2020;4:151-6. https://doi. org/10.18565/urology.2020.4.151-156
  3. Klap J, Butow Z, Champy CM, Masson-Lecomte A, Defontaines J, Taille AD, et al. 1000 retroperitoneoscopic procedures of the upper urinary tract: Analysis of complications. Urol Int. 2019;102(4):406-12. https://doi. org/10.1159/000497038
  4. Perlin DV, Dymkov IN, Davydova EA, Shmanev AO, Perlina AV. Vliyanie dostupa na uskorennoe vosstanovlenie posle operatsii pri laparoskopicheskoy radikal'noy nefrektomii [Impact of access on accelerated recovery after surgery for laparoscopic radical nephrectomy]. Onkourologiya. 2020;16(1):35-42. https:// doi.org/10.17650/1726-9776-2020-16-1-35-42
  5. Cantiello F, Veneziano D, Bertolo R, Cicione A, Fiori C, Autorino R, et al. Safe introduction of laparoscopic and retroperitoneoscopic nephrectomy in clinical practice: Impact of a modular training program. World J Urol. 2017;35(5):761- 9. https//doi.org/10.1007/s00345-016-1921-4
  6. Wang B, Tian Y, Peng Y, Ban Y, Shan G, Tan X, et al. Comparative study of retroperitoneal laparoscopic versus open ipsilateral nephrectomy after percutaneous nephrostomy: A multicenter analysis. J Laparoendosc Adv Surg Tech A. 2020;30(5):520-4. https//doi.org/10.1089/lap.2019.0746
  7. Kadyrov ZA, Odilov AYu. Sposob retroperitoneoskopicheskoy odnoetapnoy nefrektomii pri pionefroze [Method of retroperitoneoscopic one-stage nephrectomy for pyonephrosis]. Patent na izobretenie RU 2795838 C1, 12.05.2023.
  8. Kadyrov ZA, Odilov AYu, Yagudaev DM, Akramov MM. Sposob laparoskopicheskogo dostupa k pochechnoy nozhke pri radikal'noy nefrektomii [Method of laparoscopic access to the renal pedicle during radical nephrectomy]. Patent na izobretenie RU 2706504 C1, 19.11.2019
  9. Yang Q, Du J, Zhao Z-H, Chen X-S, Zhou L, Yao X. Fast access and early ligation of the renal pedicle significantly facilitates retroperitoneal laparoscopic radical nephrectomy procedures: Modified laparoscopic radical nephrectomy. World J Surg Oncol. 2013;11:27. https://doi.org/10.1186/1477-7819-11-27
  10. Mosa H, Giannettoni A, Patil K, Mishra P, Taghizadeh A, Paul A, et al. Pediatric nephrectomy: Comparison of perioperative outcomes of three different minimally invasive and open approaches. J Laparoendosc Adv Surg Tech A. 2021;31(12):1466-70. https//doi.org/10.1089/lap.2021.0343
  11. Sarhan OM. Laparoscopic nephrectomy in children: Does the approach matter? J Pediatr Urol. 2021;17(4):568.e1-568.e7. https//doi.org/10.1016/j.jpurol.2021.05.006
  12. Wang X, Tang K, Chen Z, Liu H, Peng E, Xia D. Retroperitoneoscopic nephrectomy versus open surgery for non-tuberculous pyonephrotic nonfunctioning kidney: A single-center experience. Transl Androl Urol. 2021;10(3):1212-21. https//doi.org/10.21037/tau-20-1449
  13. Li X, Liu Z-J, Liu J-W, Cai M, Chen S, Yu T, et al. A clinical comparative analysis of retroperitoneal laparoscopic tuberculous nephrectomy and open tuberculous nephrectomy. J Laparoendosc Adv Surg Tech A. 2019;29(7):909-13. https//doi. org/10.1089/lap.2018.0808
  14. Chen Y, Zheng H, Liang G, Wang D, Qiu J, Fang Y. Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for nonаfunctional tuberculous kidneys: A single-center experience. J Laparoendosc Adv Surg Tech A. 2018;28(3):325-9. https//doi.org/10.1089/lap.2017.0270
  15. Tuğcu V, Şahin S, Yiğitbaşı İ, Şener NC, Akbay FG, Taşçı Aİ. Laparoscopic donor nephrectomy, complications and management: A single center experience. Turk J Urol. 2017;43(1):93-7. https//doi.org/10.5152/tud.2016.44711
  16. Khan MMA, Patel RA, Jain N, Balakrishnan A, Venkataraman M. Prospective analysis of laparoscopic versus open radical nephrectomy for renal tumours more than 7 cm. J Minim Access Surg. 2019;15(1):14-8. https//doi. org/10.4103/jmas.JMAS_158_17
  17. Lombardo R, Martos R, Ribal MJ, Alcaraz A, Tubaro A, Nunzio CD. Retroperitoneoscopy in urology: A systematic review. Minerva Urol Nefrol. 2019;71(1):9- 16. https//doi.org/10.23736/S0393-2249.18.03235-6
  18. Perlin DV, Aleksandrov IV, Zipunnikov VP, Dymkov IN. Retroperitoneoskopicheskaya donorskaya nefrektomiya: 5-letniy opyt vypolneniya operatsii [Retroperitoneoscopic donor nephrectomy: 5 years of experience in performing operations]. Vestnik urologii. 2016;4:15-23. https://doi.org/10.21886/2308- 6424-2016-0-4-15-23

Authors' information:


Odilov Amindzhon Yusufovich,
Candidate of Medical Sciences, Doctoral Postgraduate Student of the Department of Endoscopic Urology and Ultrasound Diagnostics, Faculty of Continuing Medical Education, Medical Institute, Patrice Lumumba Peoples' Friendship University of Russia; Assistant, Department of Urology, Avicenna Tajik State Medical University, Deputy Director for Science, Republican Scientific and Clinical Center for Urology
ORCID ID: 0000-0002-8432-6512
E-mail: dr.odilov-a@mail.ru

Kadyrov Ziyoratsho Abdulloevich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Endoscopic Urology and Ultrasound Diagnostics, Faculty of Continuing Medical Education, Medical Institute, Patrice Lumumba Peoples' Friendship University of Russia
ORCID ID: 0000-0002-1108-8138
E-mail: zieratsho@yandex.ru

Sadulloev Farkhod Sanginmurodovich,
Candidate of Medical Sciences, Associate Professor, Head of the Department of Urology, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-8432-6512
E-mail: dc_farkhod1982@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Odilov Amindzhon Yusufovich
Candidate of Medical Sciences, Doctoral Postgraduate Student of the Department of Endoscopic Urology and Ultrasound Diagnostics, Faculty of Continuing Medical Education, Medical Institute, Patrice Lumumba Peoples' Friendship University of Russia; Assistant, Department of Urology, Avicenna Tajik State Medical University, Deputy Director for Science, Republican Scientific and Clinical Center for Urology

734026, Republic of Tajikistan, Dushanbe, I. Somoni str., 59

Tel.: +992 (918) 688905

E-mail: dr.odilov-a@mail.ru

Materials on the topic: