Fast access and early ligation of the renal pedicle significantly facilitates retroperitoneal laparoscopic radical nephrectomy procedures: modified laparoscopic radical nephrectomy

World Journal of Surgical Oncology

Xin Yao¹  Lei Zhou¹  Xu-Sheng Chen¹  Zhi-Hua Zhao¹  Jun Du¹  Qing Yang¹ 

[1] Department of Genitourinary Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, 300060, People’s Republic of China

关键词: Surgical outcomes;    Experience;    Operation time;    Technical modification;    Retroperitoneal laparoscopic nephrectomy;   

Others  :  826401
DOI  :  10.1186/1477-7819-11-27

 received in 2012-10-03, accepted in 2013-01-06,  发布年份 2013

【 摘 要 】

Background

The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique.

Methods

One 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.

Results

No 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).

Conclusions

Early 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.

【 授权许可】

   
2013 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, Clayman RV: Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol 2000, 164:1153-1159.
• [2]McDougall E, Clayman RV, Elashry OM: Laparoscopic radical nephrectomy for renal tumor: the Washington University experience. J Urol 1996, 155:1180-1185.
• [3]Clayman RV: Laparoscopic radical nephrectomy. J Urol 2002, 168:872.
• [4]Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O, Ohshima S: The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol 2001, 165:1867-1870.
• [5]Gill IS: Laparoscopic radical nephrectomy for cancer. Urol Clin North Am 2000, 27:707-719.
• [6]Robson CJ: Radical nephrectomy for renal cell carcinoma. J Urol 1963, 89:37-42.
• [7]Wille AH, Roigas J, Deger S, Tullmann M, Turk I, Loening SA: Laparoscopic radical nephrectomy: techniques, results and oncological outcome in 125 consecutive cases. Eur Urol 2004, 45:483-488. discussion 488–489
• [8]Rassweiler JJ, Schulze M, Marrero R, Frede T, Palou Redorta J, Bassi P: Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery? Eur Urol 2004, 46:690-697.
• [9]Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. Trans Am Assoc Genitourin Surg 1968, 60:122-129.
• [10]Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol 1969, 101:297-301.
• [11]Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thomson PG, Long SR: Laparoscopic nephrectomy: initial case report. J Urol 1991, 146:278-282.
• [12]Permpongkosol S, Chan DY, Link RE, Jarrett TW, Kavoussi LR: Laparoscopic radical nephrectomy: long-term outcomes. J Endourol 2005, 19:628-633.
• [13]Gill IS, Schweizer D, Hobart MG, Sung GT, Klein EA, Novick AC: Retroperitoneal laparoscopic radical nephrectomy: the Cleveland clinic experience. J Urol 2000, 163:1665-1670.
• [14]Gao J, Guo G, Jie Z, Wei W, Xu A, Dong J, Hong B: A fast method to identify renal vessels during retroperitoneal laparoscopic nephrectomy. J Endourol 2008, 22:1705-1708.
• [15]Porpiglia F, Terrone C, Cracco C, Renard J, Musso F, Grande S, Scarpa RM: Direct access to the renal artery at the level of treitz ligament during left radical laparoscopic transperitoneal nephrectomy. Eur Urol 2005, 48:291-295.
• [16]Porpiglia F, Terrone C, Cracco C, Cossu M, Grande S, Musso F, Renard J, Scarpa RM: Early ligature of renal artery during radical laparoscopic transperitoneal nephrectomy: description of standard technique and direct access. J Endourol 2005, 19:623-626. discussion 626–627
• [17]Porpiglia F, Renard J, Billia M, Morra I, Scoffone C, Cracco C, Tarabuzzi R, Terrone C, Scarpa RM: Left laparoscopic radical nephrectomy with direct access to the renal artery: technical advantages. Eur Urol 2006, 49:1004-1010.
• [18]Tunc L, Canda AE, Polat F, Onaran M, Atkin S, Biri H, Bozkirli I: Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique. Surg Laparosc Endosc Percutan Tech 2011, 21:453-457.
• [19]Dunn MD, Shalhav AL, McDougall EM, Clayman RV: Laparoscopic nephrectomy and nephroureterectomy for renal and upper tract transitional cell cancer. Semin Laparosc Surg 2000, 7:200-210.