BERKELEY, CA (UroToday.com) – 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).
I performed 1 hand assist lap nephrectomy for XGP. It was one of the most difficult operations I have ever done. I would recommend starting with a hand assist and this is probably 1 operation I would not think I could finish robotically. Starting robotically and converting to hand assist laparoscopy early on is an option for experienced robotic renal surgeons.