Surgical methods and clinical effects of anatomical retroperitoneal laparoscopy radical ne-phrectomy

Abstract

Objective To introduce the technique and clinical effect of anatomical retroperitone-al laparoscopy radical nephrectomy. Methods A total of 187 patients underwent anatomical retroperito-neal laparoscopy radical nephrectomy. Among them,103 cases of tumor located in the left kidney and 84 cases located in the right kidney. The maximum diameter of tumor was 2. 0 to 8. 2 cm,with an average di-ameter of 4. 6 cm. Retroperitoneal space was created routinely at lateral decubitus position. Relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota’s fascia. In the first place,the greater psoas was identified as the dorsal marker. Then the diaphragmatic muscle was identified as the posterior mark of the upper pole of the kidney,and the adrenal gland as the medial marker of the upper pole of the kidney,and the peritoneum as the ventral maker,and the inferior vena cava and abdominal aorta was the medial marker. Iliac blood vessels was the mark of Gerota’s fascia cone tip. Results All operations were successful,with no case transferred to open operation. No case had blood transfusion and severe complications during surgery. The mean operative time was 110 min （range from 90 to 150 min）. The mean intraoperative blood loss was 75 ml（range from 60 to 100 ml）. Average days to oral intake and ambulation were 1. 3 and 1. 2 days. All patients discharged from hospital on 3 to 7 days after surgery. One hundred and forty-two patients were followed-up for 6 to 42 months. Only one case suffered from retroperitoneal lymph mode metastasis. Others had no local recurrence or dis-tant metastasis by ultrasound and chest X ray inspection. Conclusions Anatomical retroperitoneal lapa-roscopy radical nephrectomy is a safe and effective procedure. It can decrease operation time,blood loss and complication rates effectively,and provide a better choice for the patient whom demand radical ne-phrectomy. Key words: Radical nephrectomy; Retroperitoneal laparoscopy; Anatomy