Single center experience with laparoscopic renal biopsy

Abstract

Introduction: Renal biopsy continues to be a pivotal tool and frequently indispensable diagnostic procedure in the clinical assessment of microscopic hematuria and proteinuria of glomerular origin or unexplained renal disease. Closed percutaneous biopsy is currently the standard approach. However, there are still some patients for whom a percutaneous approach is risky with the only remaining option being a renal biopsy under direct vision (such as mandatory chronic anticoagulation, bleeding diathesis, solitary kidney and morbid obesity). When percutaneous biopsy is contraindicated, a laparoscopic biopsy is an attractive option because it is minimally invasive. We presented our experience and outcome of laparoscopic renal biopsy in nine patients. Materials and Methods: Seven patients who had abnormal proteinuria of >150 mg/24 hr and two patients who had renal insufficiency were referred for a laparoscopic renal biopsy. All patients were felt to be unsuitable candidates for a percutaneous renal biopsy, one patient due to obesity, two patients due to solitary kidney and six patients due to a hypoplastic contralateral kidney. Four women and five men underwent laparoscopic renal biopsy. The kidney was approached via a laparoscopic retroperitoneal route using three port techniques. The mid-lower pole of the kidney was localized using blunt dissection, laparoscopic biopsies were performed. The biopsy site was fulgurated with an argon beam coagulator. Results: All biopsies were successfully completed laparoscopically with sufficient tissue obtained for histopathological diagnosis in all cases without any major complications. Mean operative time 58 minute (range: 30-90). No patient had gross hematuria postoperatively. Mean hospital stay was 2.3 days (range: 2-3). Conclusion: Laparoscopic renal biopsy is a safe and effective alternative to open renal biopsy for patients in whom percutaneous biopsy is not feasible.