Laparoscopic renal biopsy: a 9‐year experience

Open Access
Publisher Website
Google Scholar
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.