What are the contraindications for extraperitoneal nephrectomy?

Updated: Sep 24, 2019
  • Author: Michael Grasso, III, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Answer

There are no discreet contraindications specific to retroperitoneal laparoscopic nephrectomy. Indeed, many of the same conditions that prohibit any laparoscopic or open surgical intervention also apply to the retroperitoneal approach. Retroperitoneal access may be challenging in patients with prior retroperitoneal or percutaneous renal surgery and in patients with a history of pyelonephritis or genitourinary tuberculosis, which may lead to significant scarring and prevent adequate development of the retroperitoneum potential space required for renal dissection.

Care should be used in patients with a history of abdominal aortic or iliac artery aneurysms in that these structures may be, in general, friable. In addition, the renal vasculature is often tortuous and distorted by a saccular aortic aneurysm. Intraoperative sonography with color Doppler using a 10-MHz laparoscopic probe is useful in defining complex renal vasculature in this and other settings.


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