Retroperitoneal Laparoscopic Partial Nephrectomy: Surgical Experience and Outcomes

Abstract

We present outcomes in 110 consecutive patients who underwent retroperitoneal laparoscopic partial nephrectomy performed in a 72-month period by a single surgeon (MG). Patients were placed in the flank position and the retroperitoneal space was developed using a balloon dissector. Hilar control was achieved with bulldog clamps. Tumor depth and extent were evaluated using intraoperative sonography. Perioperative data were assessed and outcomes were retrospectively analyzed at a mean followup of 23 months. Mean patient age was 62 years. Mean operative time was 199.7 minutes and mean postoperative stay was 2.6 days. Mean blood loss was 260.0 ml and mean tumor size was 2.4 cm. Final pathological evaluation revealed negative positive margins in these cases. Of all tumors 63.7% were pathologically confirmed renal cell carcinoma. In 57 patients mean preoperative and postoperative creatinine was 1.1 and 1.3 mg/dl, respectively, at a mean of 20.6 months. In 47 patients with renal cell carcinoma who underwent computerized tomography or magnetic resonance imaging during the mean 23-month followup there was 1 incidence of local recurrence at 1 year. Conversion to open surgery occurred in 2 cases and laparoscopic radical nephrectomy was performed in 4. The rate of major complications was 4.5%. Although it is technically challenging, the retroperitoneal approach to laparoscopic partial nephrectomy can be performed in a safe and timely manner with perioperative outcomes comparable to those reported for open and transperitoneal approaches. Furthermore, this approach allows the containment of blood and urine outside the peritoneal cavity. Our intermediate term results revealed excellent cancer control and preserved renal function.