Abstract
BackgroundThe objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique.MethodsOne hundred retroperitoneal laparoscopic nephrectomies were performed from February 2007 to October 2011. The previous technique was performed in 60 cases (Group 1). The modified technique (n = 40) included fast access to the renal pedicle according to several anatomic landmarks and early ligation of renal vessels (Group 2). The mean operation time, mean blood loss, duration of hospital stay conversion rate and complication rate were compared between the groups.ResultsNo significant differences were detected regarding mean patient age, mean body mass index, and tumor size between the two groups (P >0.05). The mean operation time was 59.5 ± 20.0 and 39.5 ± 17.5 minutes, respectively, in Groups 1 and 2 (P <0.001). The mean intraoperative blood loss was 147 ± 35 and 100 ± 25 ml, respectively, in Groups 1 and 2 (P <0.001). No significant differences were detected regarding the conversion rate and the complication rate between the two groups (P >0.05).ConclusionsEarly ligature using fast access to the renal vessels during retroperitoneal laparoscopic radical nephrectomy contributed to less operation time and intraoperative blood loss compared with the previous technique. In addition, the modified technique permits the procedure to be performed following the principles of open radical nephrectomy.
Highlights
The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique
Laparoscopic radical nephrectomy has been accepted as the gold standard for the treatment of renal cell carcinoma confined to the kidney without deteriorating the oncologic outcome [1,2,3,4,5,6,7,8]
We describe fast access and early ligation of the renal pedicle during retroperitoneal laparoscopic radical nephrectomy and we compare this technique with the standard one
Summary
The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique. Owing to the difficulty of direct access to renal vessels, regardless of whether the transperitoneal, retroperitoneal or hand-assisted approach is employed, this principle is often not performed in laparoscopic radical nephrectomy [3,7,12,13,14]. Porpiglia and colleagues developed a modified technique of direct access to and early ligation of the renal artery at the level of the Treitz ligament, permitting the surgeon to follow the classic steps and principles of radical nephrectomy, which have driven open surgery techniques for several years [15,17]. Fast access and early ligation of renal vessels in retroperitoneal laparoscopic radical nephrectomy have not been reported
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