-Case Reports-

Rhabdomyolysis after Retroperitoneal Laparoscopic Radical Nephrectomy in the Lateral Decubitus Position

Masato Yanagi¹, Tsutomu Hamasaki², Kojiro Morita³, Hayato Takeda¹, Jun Akatsuka¹, Yuki Endo¹, Tatsuro Hayashi¹ and Yukihiro Kondo¹

¹Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
²Department of Urology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
³Department of Urology, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan

Postoperative rhabdomyolysis is a rare but potentially fatal surgical complication. We experienced a case of rhabdomyolysis after laparoscopic radical nephrectomy (LRN). Right renal carcinoma was diagnosed in a 31-year-old woman with a body mass index of 28.5 kg/m². She underwent right retroperitoneal LRN in the lateral decubitus position. The operating time was approximately 5 hours. Immediately after surgery, she reported pain in the left buttock, and reddish discoloration of the urine was observed. On the basis of these symptoms, an elevated serum creatine kinase level, and computed tomography findings, we diagnosed rhabdomyolysis of the left gluteal muscle secondary to its intraoperative compression caused by prolonged placement in a fixed position. She was treated with hydration therapy and discharged 6 days postoperatively. Prolonged surgery, obesity, and placement in the lateral decubitus position are risk factors for postoperative rhabdomyolysis. Surgeons should attempt to reduce operating time for LRN when obese patients are placed in the lateral decubitus position.

J Nippon Med Sch 2022; 89: 466-468

Keywords
rhabdomyolysis, laparoscopic radical nephrectomy, retroperitoneal approach, lateral decubitus position

Correspondence to
Masato Yanagi, Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
area-i@nms.ac.jp

Received, January 19, 2021
Accepted, March 17, 2021