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Retroperitoneal laparoscopic renal biopsy: an 8 year experience at a single centre

  • Nephrology - Original Paper
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Abstract

Purpose

To present our experience and outcome of consecutive laparoscopic renal biopsy (LRB) in a series of Chinese patients over an 8 year period.

Methods

Between January 1, 2013, and December 31, 2020, 104 patients (M/F 71/33, age 43.6 ± 16.0 years) were enrolled. All patients underwent LRB for various indications, e.g., dialysis dependence (33.7%), serum levels of creatinine ≥ 442 μmol/L (20.2%), morbid obesity (18.3%), uncontrolled severe hypertension (14.4%), aberrant renal anatomy (5.8%), solitary kidney (2.9%), deaf-mutes (2.9%), failed percutaneous biopsy (1.0%) and patient choice (1.0%). The kidney was approached via the laparoscopic retroperitoneal route using a three-port technique. Then, 16-gauge true-cut needle biopsy was performed and haemostasis was achieved by compression. Topical collagen mesh was used if necessary.

Results

Renal tissue was obtained in all cases. The operative time and amount of blood loss were significantly (P < 0.05) lower in 2017–2020 than 2013–2016 [42.6 ± 1.5 min and 9.6 ± 0.7 mL, respectively (n = 61) vs. 51.2 ± 1.3 min and 14.4 ± 0.9 mL, respectively (n = 43)], while the hospital stay was not significantly different between the two periods. The rate of tissue adequacy and median number of glomeruli were significantly higher in 2017–2020 than 2013–2016 [100% and 52 (IQR 24–94), respectively vs. 93% and 35 (IQR 6–98), respectively). Two postoperative complications occurred in the first 4 years: disseminated intravascular coagulation (DIC) during the operation and injury at the hilum of the kidney (n = 1 each). The renal pathological diagnoses were also complex: 70.2% of the cases were independent pathological types, including IgA nephropathy (IgAN) (13.5%), Henoch-Schönlein purpura nephritis (HSPN) (2.9%), focal segmental glomerulosclerosis (FSGS) (9.6%), membranous glomerulonephritis (MN) (1.9%), lupus nephritis (LN) (3.8%), crescentic glomerulonephritis (CreGN) (7.7%), diabetic nephropathy (DN) (10.6%), tubulointerstitial nephritis (TIN) (11.5%) and malignant hypertensive nephropathy (MHTN) (8.7%). However, the rates of combinations of two and three pathological types were 25.0% and 4.8%, respectively.

Conclusion

Retroperitoneal LRB is a safe, reliable, minimally invasive alternative for patients in whom PRB in not feasible. As a helpful supplement to PRB, it may be necessary to use this technique more often in the future.

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Acknowledgements

This work was financed by Elite Medical Professionals project of China-Japan Friendship Hospital (NO.ZRJY2021-BJ07) and the National Natural Science Foundation of China (81870495).

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Authors and Affiliations

  1. Department of Nephrology, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China

    Guming Zou, Wenge Li & Li Zhuo

  2. Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China

    Haixin Chen & Xiaofeng Zhou

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  1. Guming Zou
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  2. Haixin Chen
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  3. Xiaofeng Zhou
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  4. Wenge Li
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  5. Li Zhuo
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Correspondence to Li Zhuo.

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Zou, G., Chen, H., Zhou, X. et al. Retroperitoneal laparoscopic renal biopsy: an 8 year experience at a single centre. Int Urol Nephrol 55, 969–973 (2023). https://doi.org/10.1007/s11255-022-03324-z

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  • DOI: https://doi.org/10.1007/s11255-022-03324-z

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