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UKZN study recommends laparoscopic nephrectomy as standard of care for nephrectomy in SA

Dr Haroun Patel oversees the successful laparoscopic nephrology procedure, conducted at Saint Aidan’s hospital, by Dr Ozair Alli.
Dr Haroun Patel oversees the successful laparoscopic nephrology procedure, conducted at Saint Aidan’s hospital, by Dr Ozair Alli.

It is possible to implement laparoscopic nephrectomy (LN) as the standard procedure for nephrectomies in South Africa, according to the results of a study conducted by UKZN honorary lecturer, Dr Avikar Singh, and colleague, Dr Ronald Urry of the Sefako Makgatho Health Sciences University in Ga-Rankuwa.

The study, with Singh as the main author, examined the feasibility of LN versus open nephrectomy (ON) in resource constrained developing world hospitals.

According to Singh, who is also a junior consultant urologist at Saint Aidan’s Regional Hospital in Durban, LN is the standard of care for nephrectomy in most developed countries, but its adoption in a South African setting is limited due to the lack of specialised equipment and expertise.

"LN is defined as a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the larger incision required with traditional open surgery," said Singh.

The patient files of 196 people who underwent nephrectomy during the period I January 2011 to 3 December 2015 at Grey’s Hospital in Pietermaritzburg and St Aidan’s Hospital in Durban were examined during the five-year retrospective study.

During this period, ON was performed on 73% of patients and LN on 27%. Conversion from LN to ON was 11% during this time. The study found the estimated blood loss and transfusion rates were much lower in the LN group.

Also, the average hospital stay for the LN group was much shorter (five days vs 10 days).

The study also found that 82.5% of patients in the LN group had no complications compared to the ON rate of 9.9%. "LN appears feasible for use in the state sector and highlights the need for more laparoscopic training. This should also be considered as standard care in SA."

A successful LN was performed at Saint Aidan’s Hospital recently by a team in collaboration with Dr Ozair Alli, a urologist in private practice, and with equipment sponsored by Ethicon. It was the hospital’s first procedure in which a kidney was removed through three small holes in a 14-year-old female patient. The patient had a congenital shrunken kidney resulting in pain and hypertension.

Dr Haroun Patel, head of UKZN’s Department of Urology, who oversaw the surgery together with Alli and the Head of the Clinical Unit: Urology at St Aidan’s, Dr David Batuule, said: "The patient was pain-free the day following surgery and was discharged several days earlier than if the procedure had been performed through ON. The successful commencement of a major urological laparoscopic service at the Saint Aidan’s Hospital, represents a milestone for urology in Durban," said Patel.

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