Posterior approach for retroperitoneal laparoscopic bilateral native nephrectomy in prone position: initial experience with four cases.

Focal segmental glomerulosclerosis (FSGS) is known to recur in some patients after renal transplantation. Recently, laparoscopic nephrectomy has been introduced as a minimally invasive surgery. We present our experience with our first four patients with FSGS who underwent simultaneous bilateral native nephrectomy in the prone position by means of retroperitoneal laparoscopy before renal transplantation. This procedure provided adequate visualization and created enough working space for manipulation. The patients did not need to be repositioned. The mobilized specimens were removed through an incision extending from the first port or by means of morcellation within the sack. Mean operative time was 325 min and mean blood loss was 281 mL. The average time to resumption of oral intake was 1.3 days and all patients started ambulation on postoperative day 1. No major complications were observed. In conclusion, this procedure may become a useful option for native nephrectomy for FSGS patients before transplantation.