Transperitoneal Laparoscopic Partial Nephrectomy Research Articles

Transperitoneal vs. Retroperitoneal Approach in Laparoscopic Partial Nephrectomy for Posterior Renal Tumors: A Retrospective, Multi-Center, Comparative Study

Purpose: The aim of our study is to compare the perioperative, functional, and oncological outcomes of laparoscopic transperitoneal partial nephrectomy (LTPN) and laparoscopic retroperitoneal partial nephrectomy (LRPN) for posterior cT1 renal tumors. Methods: We retrospectively collected data on all patients who consecutively underwent LTPN and LRPN for posterior cT1 renal tumors in three different centers from January 2015 to January 2023. Patients with a single, unilateral, cT1 renal mass, located in the posterior renal surface were included. Patients’ data regarding perioperative, functional, and oncological outcomes were collected from medical records and statistically analyzed and compared. Results: A total of 128 patients was obtained, with 53 patients in the LPTN group and 75 patients in the LRPN group. Baseline characteristics were similar. Warm ischemia time (WIT) (18.8 vs. 22.6 min, p = 0.002) and immediate postoperative eGFR drop (−6.1 vs. −13.0 mL/min/1.73 m2, p = 0.047) were significantly lower in the LPTN group. Estimated blood loss (EBL) (100 vs. 150 mL, p = 0.043) was significantly lower in the LRPN group. All other perioperative and functional outcomes and complications were similar between the groups. The positive surgical margin (PSM) rate was lower in the LRPN group, although without statistical significance (7.2% vs. 13.5%, p = 0.258). Surgical success defined by Trifecta (WIT ≤ 25 min, no PSM, and no major postoperative complication) was similar between both approaches. Conclusions: LTPN has significantly shorter WIT and a significantly smaller drop in immediate eGFR when compared to LRPN for posterior renal tumors. On the other hand, LRPN has significantly less EBL than LTPN. LRPN demonstrated fewer PSMs than LTPN, albeit without statistical significance. In terms of overall surgical success, as defined by Trifecta, both approaches achieved similar results.

Port Site Recurrence After Laparoscopic Nephrectomy for Renal Cell Carcinoma --Report of Two Cases and Literature review-

A male in his 60s underwent a right transperitoneal laparoscopic partial nephrectomy procedure for a right renal tumor. Rupture of a renal cyst located close to the tumor occurred intraoperatively. The histopathological diagnosis was clear cell renal cell carcinoma (CCRCC), pT1aN0M0, G2, v0, with negative resection margins. At 84 months after surgery, computed tomography (CT) revealed a 10 mm mass in the rectus abdominis muscle at the camera port site used for the partial nephrectomy. An open lumpectomy was then performed and the histopathological diagnosis was CCRCC. One year later, a 40 mm sized mass was detected in the mesentery of the small intestine by CT, which was removed laparoscopically with part of the mesentery and diagnosed as CCRCC. Since that surgery, the patient has been free from recurrence for 8 years. A male in his 60s underwent a left retroperitoneal laparoscopic nephrectomy procedure for a left renal tumor. The histopathological diagnosis was CCRCC, pT1aN0M0, G1, v0, with negative resection margins. At 31 months after surgery, CT revealed a 32 mm mass in the retroperitoneal cavity at the right hand port site used for the laparoscopic nephrectomy. The mass was removed with part of the twelfth rib and erector spinae muscles in a lump, and the histopathological diagnosis was CCRCC. Since that surgery, the patient has been free from recurrence for 19 months. For the treatment of solitary port site recurrence of renal cell carcinoma after a laparoscopic radical/partial nephrectomy, we recommend surgical resection for a good prognosis.

Clinicoradiological parameters predicting operative difficulty in laparoscopic partial nephrectomy for renal tumors.

The number of renal tumors amenable to laparoscopic surgery is rising, both, due early detection by improved imaging techniques and due to progressive improvements in minimal access surgery. Conversion to open surgery, which is a significant event, can be minimized by proper case selection. We assessed the pre-operative factors that can predict the operative difficulty and can help in case selection, thus avoiding complications and reducing the chances of conversion to open. One hundred and sixteen patients (73 males and 43 females) with the mean age of 50.78 ± 14.2 years, meeting the inclusion criteria underwent transperitoneal laparoscopic partial nephrectomy (LPN). Various clinical, anthropometric, radiological, and pathological parameters were recorded. Intraoperative difficulty was assessed and graded on a scale of 1 (easiest) to 4 (most difficult or open conversion) by an independent observer to calculate the difficulty score, which along with the other parameters of operative difficulty, was used to calculate the difficulty scale. Significant parameters on the univariate analysis, were subjected to a multivariate analysis, to find parameters that can predict the operative difficulty. The mean age was 52 ± 14.29 years, mean size was 4 ± 1.04 cm, male:female ratio was 1.6:1, most of the tumors were exophytic (60%) and anteriorly located (62%) and had a mean perinephric fat surface density (PnFSD) of 6446.026 ± 2244 surface density pixel units (SDPU). On the univariate analysis, age >60 years, Eastern Cooperative Oncology Group performance score >1, presence of perinephric fat stranding, increased PnFSD (>10,000 SDPU), large tumor size (>4 cm), hilar/posterior location, endophytic tumors and higher clinical stage were significantly associated with intraoperative difficulty. However, on the multivariate analysis, no single factor could independently predict intraoperative difficulty in LPN for Renal tumors. It is difficult to predict the intra-operative difficulty during LPN. Feasibility of LPN should be based on multiple factors rather than a single factor.

Transperitoneal Laparoscopic and Robotic Partial Nephrectomy for Renal Cancer in Patients with Previous Abdominal Surgery: a Single Centre Experience

Patients with previous abdominal surgery are at an increased risk of peritoneal adhesions, which may complicate transperitoneal surgery. The objective of this article is to report single centre experience with transperitoneal laparoscopic and robotic partial nephrectomy for renal cancer in patients with previous abdominal surgery. We evaluated data from 128 patients who underwent laparoscopic or robotic partial nephrectomy from January 2010 to May 2020. Patients were divided into three groups according to the localization of main previous surgery: in the upper contralateral abdominal quadrant, in the upper ipsilateral abdominal quadrant or in the middle line, in lower abdominal quadrants. Each group was divided into two subgroups (laparoscopic/robotic partial nephrectomy). We separately analysed data of indocyanine green-enhanced robotic partial nephrectomy. Our study did not find significant difference in the rate of intraoperative or postoperative complications between any of the groups. The type of partial nephrectomy (robotic or laparoscopic) affected the surgery time, blood loss, and length of stay in hospital, but did not significantly influence the frequency of complications. Partial nephrectomy in group of patients with prior renal surgery led to a higher rate of intraoperative low-grade complications. We did not observe more favourable results for indocyanine green-enhanced robotic partial nephrectomy. The location of previous abdominal surgery does not influence the rate of intraoperative or postoperative complications. The type of partial nephrectomy (robotic or laparoscopic) does not affect the frequency of complications.

Feasibility of Microwave Scissors-Based Off-Clamp Laparoscopic Partial Nephrectomy in a Porcine Model.

To assess the feasibility of off-clamp laparoscopic partial nephrectomy using microwave scissors. We performed transperitoneal laparoscopic partial nephrectomy, without hilar clamping or renorrhaphy, using only microwave scissors for renal resection in a porcine model. For each kidney, 2 types of procedures were performed: a middle pole resection excising an area of 2-cm diameter and approximately 1-cm depth and a lower pole resection at the level of the lower polar line. The renal calyces exposed during renal resection were sealed and transected using microwave scissors. After 3days of follow-up, the pigs were reoperated to inspect for postoperative complications. Euthanasia was performed to collect the remaining kidneys for histopathological examination. Ten procedures were successfully performed, without hilar clamping or suturing of the renal calyces and parenchyma, in 5 kidneys from 3 pigs. The median resecting time, blood loss, and lateral thermal injury were 23.2min, 47.1mL, and 6.8mm in the middle pole resection, and were 15.1min, 26.5mL, and 6.9mm in the lower pole resection, respectively. No complications were noted during reoperation, such as postoperative hemorrhage and major urine leakage. Extravasation occurred in 2 middle pole resections and 3 lower pole resections during retrograde pyelogram. Hematoxylin and eosin staining revealed thermal injury characterized by tissue microwave fixation in the near zone and acute coagulative necrosis in the intermediate zone. Microwave scissors-based off-clamp laparoscopic partial nephrectomy is feasible in pigs and can be used for clinical applications.

Surgical strategy of laparoscopic partial nephrectomy: It is more suitable to use transperitoneal approach in anterior tumor patients and retroperitoneal approach in posterior tumor patients.

Previous surgical strategy of transperitoneal laparoscopic partial nephrectomy (TLPN) and retroperitoneal laparoscopic partial nephrectomy (RLPN) for treatment of renal cell carcinoma (RCC) mainly depend on surgeons' preference. The aim of this study was to evaluate whether performing TLPN for anterior tumors and RLPN for posterior tumors is a more beneficial strategy. 214 patients underwent TLPN or RLPN at our center were retrospectively collected and 1:1 matched for surgical approach, tumor complexity as well as operator. Baseline characteristics and perioperative outcomes were evaluated and compared, respectively. Regardless of tumor location, RLPN was associated with a faster operative time, a quicker time to first oral intake and hospital discharge compared to TLPN approach while other baseline and perioperative outcomes were comparable between groups. After taking tumor location into consideration, TLPN has an advantage in operating time (109.8 vs 115.3 mins, p = 0.03) and ischemic time (20.3 vs 24.1 mins, p = 0.001) for anterior tumor, while RLPN has an advantage in operating time (103.5 vs 116.3 mins, p<0.001), ischemic time (21.8 vs 24.8 mins, p=7 0.001) and estimated blood loss (65.5 vs 85.4ml, p = 0.01) for posterior tumor. The selection of approach should be also dependent of the tumor location, instead of only dependent of surgeons' experience or preference.

Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison.

Objective: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery. Materials and Methods: A single-institution prospective study. Forty-three patients with renal-cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by minimally invasive FloTrac/Vigileo system. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10, 30, 60 minutes following insufflation to 14 mm Hg and 10 minutes following desufflation. Results: For hemodynamic changes in the transperitoneal laparoscopic surgery (TPL) and retroperitoneal laparoscopic surgery (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP), and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p < 0.05). In contrast, CVP, AWP, and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p < 0.001; p = 0.002; p = 0.004). The mean maximum CVP in the two groups was 20 and 16 mm Hg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p < 0.001; p < 0.001). Conclusions: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significant effects on IVC hemodynamics. Elevated intra-abdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significant increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effective way to control intravenous bleeding. Clinical Trial Registry: Registration number: ChiCTR2000038291.

The feasibility and safety of adopting the left lumbar vein to localize the renal artery location during left transperitoneal laparoscopic partial nephrectomy

BackgroundLaparoscopic partial nephrectomy (LPN) is the standard of care for localized small renal cancer. The most critical step in this form of surgery is to localize the renal artery. In the present study, we describe a novel technique that uses the left lumbar vein (LV) to access the left renal artery during LPN.Materials and methodsThis was a retrospective review of 130 cases of transperitoneal laparoscopic partial nephrectomies (TLPNs) performed on patients with renal cancer in our center between January 2018 and December 2021. Either the LV or non-lumbar vein (N-LV) technique was used to locate and manage the left renal artery. We recorded relevant clinical data from all patients, including patient characteristics, tumor data, and perioperative outcomes (artery mobilization time, operative time, estimated blood loss, and complications). Comparative analysis was then carried out between the cases using LV or N-LV vein techniques.ResultsAll TLPNs were successfully accomplished without conversion to open approaches. There were no complications involving the renal vessels during the entire study. The LV technique resulted in a significantly shorter time to mobilize the renal and significantly less estimated blood loss (p < 0.05). There was no significant difference between the two techniques with regard to perioperative complications.ConclusionThe left LV represents an anatomical landmark for locating the left renal artery in TLPN. This approach has numerous advantages over the transperitoneal approach including facilitating access to the left renal artery and reducing the duration of surgery.

Impact of three-dimensional vision in laparoscopic partial nephrectomy for renal tumors.

To compare three-dimensional (3D) with standard two-dimensional (2D) laparoscopic partial nephrectomy (LPN) with respect to intra- and postoperative outcomes. Data from 112 patients who underwent transperitoneal LPN from 2012 to 2014 by a single experienced surgeon were collected. Sixty patients (group 1) underwent conventional 2D LPN and 52 patients (group 2) 3D LPN. Perioperative patient, procedure, and tumor data were recorded. The follow-up period was 1-5 years. The two groups had similar patient age (p=0.834) and body mass index (p=0.141). The total laparoscopy time (LT) was shorter in group 2 (119.0 vs. 106.0 min; p=0.009). Warm ischemia times (WITs) were also shorter in group 2 (11.5 vs. 10.0 min; p=0.032). The estimated blood loss (EBL) (350.0 vs. 250.0 mL; p<0.001) and hemoglobin (Hb) decrease (1.55 vs. 1.35 g/dL; p=0.536) were lower in the 3D LPN group. Creatinine (0 vs. 0 g/dL; p=0.610) increase and estimated glomerular filtration rate (eGFR) decrease (0 vs. 0 mL/min/1.73 m2; p=0.553) did not demonstrate statistically significant differences. Duration of hospitalization (7 vs. 7 days; p=0.099) and complication rates (p=0.559) were similar between the two groups. The new-generation 3D laparoscope has a great impact on significant LPN intraoperative parameters, mainly LT, WIT, and EBL. Hb decrease is also in favor of 3D vision, although not dramatically altered. Therefore, 3D LPN appears to be superior to conventional 2D LPNs.

Needle Adjustment Free (NAF) running suture technique (PAN suture) in laparoscopic partial nephrectomy

BackgroundIt is proposed a new running suture technique called Needle Adjustment Free (NAF) technique, or PAN suture. The efficiency and the safety were evaluated in laparoscopic partial nephrectomy.MethodsThis new running suture technique avoids the Needle Adjustment method used in traditional techniques. The new continuous suture technique (11 patients) was compared with the traditional continuous suture method (33 patients) used in both transperitoneal and retroperitoneal laparoscopic partial nephrectomy (LPN) in terms of suture time (ST), warm ischemia time (WIT), blood loss (BL), open conversion rate and post-op discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op). Differences were considered significant when P < 0.05.ResultsST in the PAN suture group was 30.37 ± 16.39 min, which was significant shorter (P = 0.0011) than in the traditional technique group which was 13.68 ± 3.33 min. WIT in the traditional technique group was 28.73 ± 7.89 min, while in the PAN suture group was 20.64 ± 5.04 min, P = 0.0028. The BL in entirety in the traditional technique group was 141.56 ± 155.23 mL, and in the PAN suture group was 43.18 ± 31.17 mL (P = 0.0017). BL in patients without massive bleeding in the traditional technique group was significantly greater than in the PAN suture group at 101.03 ± 68.73 mL versus 43.18 ± 31.17 mL (P = 0.0008). The open conversion rate was 0 % in both groups. There was no significant difference between the two groups in postoperative discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op).ConclusionsThe NAF running suture technique, or PAN suture, leading to less ST, WIT and BL, which was shown to be more effective and safer than the traditional technique used for LPN. A further expanded research with larger sample size is needed.

Laparoscopic Partial Nephrectomy in Allograft Kidney

The incidence of renal tumor on the allograft kidney is relatively rare. There is no standard treatment available for the management of such cases. However, if technically feasible nephron-sparing surgical approaches, whether open or minimally invasive, should be preferred for the management of these challenging cases. To our knowledge, there is no pure laparoscopic technique reported in the literature but only 3 cases of robot-assisted partial nephrectomy. In this article, we aimed to present the application of pure transperitoneal laparoscopic partial nephrectomy for the management of a renal mass on the allograft kidney.

Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery.

The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications (p = 0.121). However, operative time (p = 0.003) and length of stay (p < 0.001) were greater in patients with versus those without previous open cholecystectomy. Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.

AB021. Selective segmental renal artery clamping during retro and trans-peritoneal robotic-assisted laparoscopic partial nephrectomy for hilar tumours: technique and outcome

AB021. Selective segmental renal artery clamping during retro and trans-peritoneal robotic-assisted laparoscopic partial nephrectomy for hilar tumours: technique and outcome

Direct Lateral Access to Renal Artery During Transperitoneal Laparoscopic Partial Nephrectomy: Surgical Technique and Comparative Outcomes

ObjectiveTo describe a novel technique of laparoscopic partial nephrectomy (LPN) with direct lateral access (DLA) to renal artery and to report our early outcomes with this technique. Materials and MethodsA retrospective review of 135 cases of transperitoneal LPN done by a single surgeon at our tertiary care institution from August 2014 to December 2016 was performed. Standard LPN (n = 73) or DLA-LPN (n = 62) was performed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and surgical outcomes (operative time, artery mobilization time, warm ischemia time, estimated blood loss, complications, and so on). A comparative analysis between standard LPN cases and DLA-LPN was performed. ResultsThe use of DLA technique had shorter operative time (P <.001), which was mainly due to a shorter artery mobilization time (18.1 vs 25.6 minutes; P <.001). This time difference was more significant in case of “complex” renal vasculature (2 or more arteries, P <.001). There was no difference in terms of perioperative complications between the 2 techniques. ConclusionDLA to renal artery is safe and feasible, and it may translate into a shorter operative time. This can represent a useful trick to facilitate a challenging step of the LPN procedure, especially in case of complex vascular anatomy.

Case - Laparoscopic transperitoneal partial nephrectomy of T3a renal cell carcinoma within a horseshoe kidney.

Horseshoe kidney (HSK) is a benign malformation characterized by three anatomic abnormalities: ectopia, malrotation, and vascular changes.1 Renal cell carcinoma (RCC) comprises approximately 53.8% of HSK malignancies. The incidence of RCC within HSK is predicted to equal that within the general population, approximately 5.2/100 000 individuals.2-4 Surgical resection of these tumors has been described in the literature. Evidence is mounting that partial nephrectomy, rather than radical nephrectomy, and minimally invasive techniques for T3a RCC is safe and attains equivalent oncologic outcomes.5,6 Review of the literature reveals no case reports of laparoscopic partial nephrectomy for T3a RCC, and therefore, this is the first report of a laparoscopic partial nephrectomy of T3a RCC HSK with renal vein tumour thrombus.

Retroperitoneoscopic partial nephrectomy for renal cell carcinoma: A single-center Indian experience

Objective:Retroperitoneoscopy, by avoiding peritoneal breach and injury to intra-abdominal organs, provides a more direct and rapid access to the kidney and the renal hilum. Laparoscopic partial nephrectomy by retroperitoneal route (LPNR) is less commonly performed than transperitoneal route for early stage renal cancer. The objective of this study is to carry out the outcomes of partial nephrectomy using retroperitoneal approach.Materials and Methods:Patients, who underwent LPNR from period 2008 to 2014, were retrospectively analyzed. Outcomes of interest included demographic data, preoperative data, perioperative variables, surgical complications, recurrence of disease, and mortality, if any, during their follow-up.Results:Among 24 patients, 16 were male, and 8 were female. Mean age and mean body mass index, respectively, were 49.16 years (range: 25–75) and 25.35 kg/m2 (17.84–34.25). Among renal masses, the right-sided to left-sided distribution was 13:11. The proportions of low-risk and intermediate-risk nephrometry score (NS) cases were 13 (54.17%) and 11 (45.83%), respectively, as assessed by renal NS. Mean operative duration, mean warm ischemia time, mean estimated blood loss, and mean hospital stay, respectively, were 132.5 min (90–170), 21.83 min (15–44), 106 ml (25–300) ml, and 5.25 days. During the postoperative period, complications encountered were lung atelectasis in one, bleeding in two, and urinary leakage in one. Histopathology revealed malignancy in 23 patients and leiomyoma in the remaining one. All patients but two experienced a disease free survival during a median follow- up period of 33 months.Conclusion:Overall outcomes for LPNR is comparable to the outcomes for open and transperitoneal laparoscopic partial nephrectomy mentioned in the literature and is equally safe for the right-sided and left-sided lesions.

Transperitoneal laparoscopic nephrectomy: Assessing complication risk in cases of previous abdominal surgery.

We aimed to assess the effect of previous abdominal surgery on perioperative outcomes in patients undergoing transperitoneal laparoscopic partial (LPN) or radical (LRN) nephrectomy for renal masses. We retrospectively reviewed all cases of LPN and LRN for renal masses at our institution between 2008 and 2014. Patients were divided in two groups, those with and without prior abdominal surgery. Four perioperative outcomes were compared, namely, operative time (OT), estimated blood loss (EBL), length of stay (LOS), and 30-days complications rate. A subanalysis was performed to address the impact of previous open cholecystectomy on right LPN or LRN. Of 293 patients identified, 146 (49.8%) had previous abdominal surgery. In univariate analysis, no differences in operative time (136 vs. 144 minutes; p=0.154), EBL (88 vs. 100 mL; p=0.211), or 30-day complication rate (24 vs. 14%; p=0.069) were recorded between the groups. Only LOS favoured patients without previous abdominal surgery (3 vs. 4 days; p=0.001). In multivariate analysis, prior abdominal surgery was not associated with an increased OT, EBL, LOS, or complication rate. The analysis of right nephrectomies showed increased OT (148 vs. 128 minutes; p=0.049) and complication rate (42 vs. 16%; p=0.004) for patients with past open cholecystectomy compared to those without. Multivariate analysis revealed that prior open cholecystectomy was associated with a longer LOS (ORmedian=2.7 [1.2-8.0]) and an increased risk of complications (ORmedian=4.5 [1.6-10.5]). In this cohort, previous abdominal surgery was not associated with worse perioperative outcomes after transperitoneal LPN and LRN for renal masses. However, previous open cholecystectomy resulted in a higher risk of complication and a longer LOS in patients undergoing right laparoscopic nephrectomy.

The impact of gender difference on operative time in laparoscopic partial nephrectomy for T1 renal tumor and the utility of retroperitoneal fat thickness as a predictor of operative time.

BackgroundTo investigate the impact of biological gender on operative parameters, especially operative time, in laparoscopic partial nephrectomy (LPN) for T1 renal tumor.MethodsOne hundred and eleven (28 female and 83 male) patients and 64 (20 female and 44 male) patients with renal tumors suspected to be RCC cT1aN0M0 who underwent retroperitoneal and transperitoneal LPN, respectively, were analyzed. The influence of sex on operative factors including retroperitoneal fat tissue thickness, determined on CT, was analyzed. The correlation between operative time and gender was evaluated by unpaired t-test and linear logistic regression model.ResultsIn both retroperitoneal and transperitoneal LPN, the retroperitoneal fat tissue thickness was greater in men than in women. In retroperitoneal LPN, the operative time was significantly longer in men than in women. In contrast, in transperitoneal LPN, no gender difference was observed in regard to the operative time. In retroperitoneal LPN, linear logistic regression assessment showed that gender, retroperitoneal fat tissue thickness, and tumor size were significantly associated with operative time. Coefficient of determination of the prediction model was 0.317.ConclusionsThe operative time of retroperitoneal LPN is significantly correlated with gender, maximum tumor diameter, and retroperitoneal fat tissue thickness. We have developed a prediction model for the operative time of retroperitoneal LPN based on preoperative parameters. Interestingly, in transperitoneal LPN, a gender difference in operative time was not apparent, and also predicting operative time might be difficult.

Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia.

To elucidate the impact of renal parenchymal loss and the ischemic reperfusion injury (RI) on the renal function after laparoscopic partial nephrectomy (LPN) under warm ischemia (WI). Thirty-five patients with a single polar renal mass ≤4cm and normal contralateral kidney underwent LPN. Transperitoneal LPN with WI using en bloc hilar occlusion was performed. The total differential renal function (T-DRF) using 99mTc-dimercaptosuccinic acid was evaluated preoperatively and postoperatively over a period of 1year. A special region of interest (ROI) was selected on the non-tumorous pole of the involved kidney, and was compared with the same ROI in the contralateral kidney. The latter comparison was defined as partial differential renal function (P-DRF). Any postoperative decline in the P-DRF of the operated kidney was attributed to the RI. Subtraction of the P-DRF decline from the T-DRF decline was attributed to the parenchymal loss caused by the resection of the tumor and suturing of the normal parenchyma. The mean WI time was 22min, and the mean weight of resected specimen was 18g. The mean postoperative eGFR declined to 87ml/min/1.73m2 from its baseline mean value of 97ml/min/1.73m2 (p value=0.075). Mean postoperative T-DRF and P-DRF of the operated kidney declined by 7 and 3%, respectively. After LPN of small renal mass, decline in renal function is primarily attributed to parenchymal loss caused by tumor resection and suturing of the normal parenchyma rather than the RI.

Comparison of transperitoneal and retroperitoneal approach in robotic-assisted laparoscopic partial nephrectomy

Objective To compare the peri-operative outcomes of patients who underwent transperitoneal or retroperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN). Methods From September 2014 to June 2015, 103 patients with kidney neoplasms who underwent RALPN were retrospectively analyzed, including 64 males and 39 females. Their mean age was 52 years(24-80 years). Forty-four cases (29 male, 15 female) were in transperitoneal group and 59 (35 male, 24 female) in retroperitoneal group according to tumor location. The tumor size was (3.8±2.3) cm in transperitoneal group and (3.3±1.4) cm in retroperitoneal group. Results Warm ischemia time (WIT) was (23.5±5.3) min in transperitoneal group and (19.1±6.9) min in retroperitoneal group (P>0.05). WIT of dorsal mass was (26.3±6.0) min and (19.4±6.5) min (P>0.05), operation duration was (127.1±31.3) min and (91.2±24.1) min (P 0.05), and bowel recovery time was 2.2 days (2-4 days) and 1.3 days (1-2 days) (P<0.05), respectively. The operation duration, WIT of dorsal mass and bowel recovery time were obviously less in retroperitoneal group than those in transperitoneal group. Conclusions Both transperitoneal and retroperitoneal approach of RALPN were effective and safe for kidney neoplasms patient treatment. Compared with transperitoneal approach, retroperitoneal method could greatly shorten operation time, WIT of dorsal mass and bowel recovery time. Key words: Robotics; Retroperitoneal; Kidney neoplasms; Partial nephrectomy