Application of "arch window" technique in retroperitoneoscopic partial nephrectomy

Abstract

Objective To investigate the feasibility of the technique in retroperitoneoscopic partial nephrectomy.Methods The technique was performed on 128 renal carcinoma patients receiving retroperitoneoscopic partial nephrectomy between June 2012 and June 2014.There were 76 males and 52 females,with age ranging between 31-76 (average 54).The tumors were all at T1N0M0 stage of American Joint Committee on Cancer (AJCC) with diameters of 0.8-6.2 cm (average 2.6 cm) and located in the upper pole,middle,and lower pole of the kidney in 65,31 and 32 cases respectively.Medical data were collected and compared with the same practice performed without using arch window technique from April 2010 to May 2012.Results All 128 operations were successful without conversion to open surgery.There were no serious intraoperative complications such as damaged large blood vessels or adjacent organs.Thirteen patients had postoperative complications,including 8 cases of hematuresis,2 cases of subcutaneous emphysema and 3 cases of delayed healing.Three hematuria patients recovered after conservative treatment.The operation time was 55-186 min (average 89 min),and blood loss was 30-220 ml (average 60 ml).No patient needed intraoperative blood transfusion.The average renal artery occlusion time was 22 min (14-35 min).Pathological examination reported 106 renal clear cell carcinomas and 1 papillary carcinoma with negative margin; and 21 renal angiomyolipomas.Patients were followed up for 1-25 months post-operation (average 18 months).There was no tumor recurrence or distant metastasis and renal functions were normal.Arch window group had significantly shorter suture time,operation time and renal warm ischemia time,and less intraoperative bleeding than non-arch window group.Conclusion The use of technique in retroperitoneoscopic partial nephrectomy is safe and feasible.It benefits from sufficient surgery field exposure and convenient operation and is worthy of wider clinical application. Key words: Retroperitoneoscopy ; Partial nephrectomy