Transperitoneal laparoscopic nephrectomy in acute Grade 4 renal trauma with literature review and a note on some unusual complications

Abstract

Most renal traumas are successfully managed conservatively. Grade 4 and 5 trauma, however, can require nephrectomy which is almost always by laparotomy and laparoscopic nephrectomy (LN) is still considered contraindicated in acute trauma setting. We report successful transperitoneal LN in an acute grade 4 renal trauma with retroperitoneal haematoma, extensive parenchymal devascularisation and urinary extravasation though retroperitoneoscopic nephrectomy in trauma has been reported recently. However, we believe transperitoneal approach is more logical and replicates all the principles of open renal trauma surgery more accurately. A review of LN in renal trauma and some unusual problems to be anticipated during laparoscopic procedures in acute trauma setting is presented.

The emerging role of laparoscopic nephrectomy in the operative management of renal trauma: is less really more?

“…Design of included studies: 3 articles were case reports and 1 was a case series. [11][12][13][14] Region of study origin: Included studies were conducted in Australia, Italy, India and China. [11][12][13][14]…”

“…Three studies only reported on one patient as they were case reports, and one study conducted by Wang et al reported on three patients. [11][12][13][14]…”

“…The age of patients in the three case reports were 24years, 21-years and 13-years, whereas the mean age of patients in the case series article was 37 years. [12][13][14][15]…”

“…11,14 Gidaro et al described a concomitant liver injury and Valsangkar et al reported both liver and splenic injuries. 12,13 Mechanism of injury 2 case reports reported a motorcycle accident as mechanism of injury, while 1 reported fall from bicycle. The mechanism of injury in the three patients described in the case series was a low speed fall, post extracorporeal wave lithotripsy and a motor vehicle accident respectively.…”

“…The mechanism of injury in the three patients described in the case series was a low speed fall, post extracorporeal wave lithotripsy and a motor vehicle accident respectively. [12][13][14][15]…”