AB186. Laparoscopic nephropexy using a self-designed polytetrafluoroethylene “basket”

Objectives: Laparoscopic nephropexy has been reported as a minimally invasive approach for symptomatic nephroptosis. We performed five cases of laparoscopic nephropexy using a self-made polytetrafluoroethylene “basket” to fix the inferior parts of kidneys to 12^th rib.

Methods: All patients (four women and one man) had symptomatic nephroptosis presenting with flank pain, repeat hemoturine or hydronephrosis. Preoperative ultrasonography, intravenous urography and renal CT scan in supine and upright positions were done for nephroptosis diagnosis. Transperitoneal laparoscopic nephropexy were carried out using self-prepared “basket” made of stripes cutting from polytetrafluoroethylene herniorrhaphy mesh. After the kidney was completely dissected from surrounding perirenal fat, it was put into the non-absorbable polytetrafluoroethylene “basket” through multiple suturing and fixation to renal capsule. Then suspended the kidney by fixation the lower pole of kidney to the twelfth rib, and reinforced by suturing the posterior surface of the kidney to the quadratus lumborum muscle.

Results: The operation was successfully completed laparoscopically in all cases without major perioperative complications. The average operative time was 95 minutes, and the mean estimated blood loss was less than 60 mL. Hospital stay was 4.5 days (range, 3–6 days). Postoperative urography or ultrasound revealed complete resolution of loin pain and nephroptosis with a median follow-up of 8 months (range, 2–15 months).

Conclusions: Laparoscopic nephropexy using self-made polytetrafluoroethylene “basket” with a modified three-point fixation technique is an effective minimally invasive procedure for treating symptomatic nephroptosis with excellent short-term results.

Keywords: Laparoscopic nephropexy; symptomatic nephroptosis; fixation