Laparoscopic Retroperitoneal Necrosectomy: Novel Treatment of a Postnephrectomy Complication

Abstract

Introduction:

Postoperative complications after a nephrectomy can be difficult to manage. Some complications require invasive procedures that are not feasible during the perioperative period for complex patients. This video presents a novel minimally invasive technique for drainage of a postnephrectomy renal bed collection.

Materials and Methods:

A right nephrectomy was performed for polycystic kidney disease in preparation for a kidney transplant. This procedure was complicated by a duodenal perforation, which was repaired, but resulted in a persistent collection in the renal bed. This is a known, but rare, complication of a nephrectomy. ¹ The perforation also led to widespread myofascial necrosis secondary to bile leakage, which necessitated multiple debridements and skin grafts. ² Percutaneous drainage was unsuccessful because of the thick necrotic debris. Standard retroperitoneal access for minimally invasive debridement was also contraindicated because of the extensive flank wounds with skin grafts overlying normal access routes. Therefore, laparoscopic instruments were used to approach the retroperitoneal collection transinguinally. Extensive use of preoperative computed tomograms, photography, and intraoperative video are used to demonstrate the procedure.

Results:

A second laparoscopy 9 days later showed an essentially resolved collection. Debridement and drainage were effective, and the patient made a full recovery.

Conclusion:

This case demonstrates how principles of minimally invasive surgery can be applied to novel situations, such as a large collection in a difficult-to-access location, to achieve good outcomes for patients.

No competing financial interests exist.

Runtime of video: 6 mins 59 secs

Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.