Direct access to the renal artery for transperitoneal laparoscopic radical nephrectomy: the safety and feasibility

Abstract

Objective To compare different methods for blockage of renal artery in transperitoneal laparoscopic radical nephrectomy,and evaluate the safety and feasibility of direct access to the renal artery.Methods From May 2008 to December 2010,64 patients with T1N0M0-T2N0M0 stage renal carcinoma underwent transperitoneal laparoscopic radical nephrectomy using a standard procedure to isolate and block renal artery(group A,33 patients) or a direct access to the renal artery via ligament of Treitz(left side) or aorta-inferior vena cava(right side;group B,31 patients).The age,gender,body mass index(BMI),history of previous abdominal surgery,tumor side,tumor maximum diameter,and preoperative TNM stages were all matchable between the two groups.Results One patient in group A was conversed to open surgery due to extensive perirenal adhesion and the others successfully received transperitoneal laparoscopic radical nephrectomy.The operation time,estimated blood loss,intraoperative and postoperative complications,postoperative TNM stage,postoperative fasting time,postoperative indwelling time of drainage tube,postoperative hospital stay and pathological types were similar between the two groups.Patients with T2 stage tumors in Group B had less intraoperation blood loss than those in Group A(P0.05).Conclusion Direct access to the renal artery is feasible and safe of transperitoneal laparoscopic radical nephrectomy.The method not only fulfils the tumor-free principles and reduces intraoperative blood loss,but also broadens the indications of laparoscopic operations for renal cell carcinoma.