Results

Several authors have published reports on laparoscopic renal biopsy by both transperitoneal (12,13) and retroperitoneal (8,14,18-20) approaches, including biopsies in children involving minor technical modifications (21). The largest series is reported by Shetye et al. (8) in which 74 patients underwent retroperitoneal laparoscopic renal biopsy over a nine-year period from 1991 to 2000. These authors obtained adequate tissue in 96% of their cases, which is similar to 100% rates of recovery from other published series (13,14). Shetye et al. reported an overall complication rate of 13.5%, the most common complication being bleeding, which was observed in 3 of 74 (4%) patients (8). Only one bleed was significant, involving a 2000 mL blood loss. These authors also reported one death seven days following uneventful biopsy in a patient with a lupus flare who was treated with high-dose steroids after the renal biopsy and subsequently died of a perforated gastric ulcer after refusing transfusion or surgery to explore the source of her abdominal pain (8). Complication rates from other reported series range from 11.8% (14) to 50% (13) and include subcutaneous emphysema (13), transient postoperative gross hematuria (14), per-inephric hematoma (not requiring transfusion) (8), initial biopsy of nonrenal tissue (8), and inability to obtain tissue (8). Caione et al. (21) reported a single intraoperative complication (5%) of a peritoneotomy and one open conversion in 20 pediatric patients. While most reported complications in the literature have been minor, there is one case report of pneu-mocephalus following retroperitoneal laparoscopic renal biopsy, which is hypothesized to have resulted from an inadvertent disruption of the dura mater along an intercostal nerve or the lumbar plexus, which presumably occurred during placement of the 5-mm trocar (22). In addition, this same patient also suffered new-onset right lower extremity numbness and paralysis following the procedure, which was believed to have resulted from positioning during the procedure. The patient's pneumocephalus resolved without further intervention, and her paralysis resolved following aggressive physical therapy (22).

Laparoscopic renal biopsy is generally well tolerated. The majority of patients return home within 24 hours, with most of the remaining patients being discharged within 48 hours. Most patients who remain longer than this duration do so secondary to medical comorbidities or to reinitiate anticoagulation (8,15).

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