Laparoscopic renal biopsy: a 9‐year experience

Abstract

Renal biopsy is a frequent procedure in patients with suspected intrinsic renal disease. In some patients the blind percutaneous approach is contraindicated; the authors from Johns Hopkins describe their experience over a 9‐year period using a laparoscopic approach. They found that adequate tissue could be obtained for biopsy in the large majority of cases, and that complications occurred in a tiny minority. Most patients were discharged within 24 h. They indicate the advantages in removing tissue by this method. Authors from Varanasi, India describe how artificial neural networks were used in an attempt to predict optimum renal stone fragmentation in patients undergoing ESWL. They were encouraged by the findings in what was essentially a pilot study, and felt that with a larger data set, the value of their network system could be enhanced. OBJECTIVES To present our experience and outcome of consecutive laparoscopic renal biopsy over a 9‐year period, as renal biopsy remains an important diagnostic procedure for evaluating proteinuria, haematuria and renal failure, but when percutaneous biopsy is contraindicated, a laparoscopic biopsy is an attractive option because it is minimally invasive. PATIENTS AND METHODS Seventy‐four patients (29 male, 45 female, mean age 45 years, range 3–79) had a laparoscopic renal biopsy taken for various indications, e.g. morbid obesity, solitary kidney, coagulopathy, failed percutaneous biopsy, high location of the kidney and poor visualization with ultrasonography. The kidney was approached via a laparoscopic retroperitoneal route using a two‐port technique, with the patient in the flank position. After identifying the kidney, one to five cortical biopsies were obtained with cup‐biopsy forceps. RESULTS Adequate tissue was obtained in 96% of the patients; the mean (range) operative duration was 123 (9–261) min and the estimated blood loss 67 (5–2000) mL. Forty‐three patients were discharged within 24 h. Complications occurred in 10 patients, with significant bleeding in three. One patient died after surgery, secondary to a perforated peptic ulcer while on high‐dose steroid therapy. CONCLUSION Laparoscopic renal biopsy is a safe and effective alternative to open renal biopsy for patients in whom percutaneous biopsy is not feasible. It offers the advantage of obtaining cortical biopsies and achieving haemostasis under direct vision. Adequate renal tissue is obtained in most cases. Recovery and convalescence are short for most patients.

Retroperitoneoscopic renal biopsy in children

“…Renal biopsy was reinforced after the report by Iversen & Braun showing PNRB as a safe, easy and less morbid method (15 Although PNRB is the standard procedure to obtain renal tissue samples nowadays, it is not indicated in different situations such as noncollaborative patients, failure to obtain samples for pathology tests, solitary kidney, morbid obesity and hematological disorders (1-4). In these cases, some authors suggest laparoscopic approach as an alternative to ORB (7)(8)(9)(10)(11)(12)16).…”

“…In laparoscopic approach, blood loss is minimized because biopsy bed is controlled quickly under direct view, which is not possible in PNRB. Another advantage of LRB is the high positivity about the renal samples (almost 100%) different from the needle method, which is around 90% of renal fragments (12,(16)(17)(18). We believe LRB eliminates the necessity of another procedure.…”

“…Obesity could complicate retroperitoneal access (16,19,20). It occurred in an obese patient, leaving a perirenal hematoma.…”

“…Complication rate in this series of 74 patients (aged 3 to 74 years old) was 20%. The most frequent type of complication was hemorrhage, comprising 20% of all (16).…”

Gasless Laparoscopic Anatomy and Renal Biopsy of the Kidney in the Standing Mare

“…Renal biopsy often gives valuable information in deciding prognosis and guiding therapy. Although several methods were available, percutaneous renal biopsy was the most common method of sampling renal tissue because it is minimally invasive and can be performed under local analgesia (Manoligod & Pirani, 1985;Shetye et al, 2003). About 5 to 20% of percutaneous renal biopsy cases were yielded inadequate tissue for histopathology diagnosis (Wickre & Golper, 1982).…”