Laparoscopic Nephrectomy Using a Retroperitoneal Approach: Comparison With a Transabdominal Approach

Abstract

To evaluate the efficacy of the retroperitoneal approach in laparoscopic nephrectomy, our procedures involving laparoscopic nephrectomy using a retroperitoneal approach are described and the clinical results of six patients treated in this way are compared with those of 32 transabdominally nephrectomized patients. Of the six retroperitoneally nephrectomized patients, six kidneys were successfully removed without severe complication, and 28 kidneys were successfully removed in the 32 intraabdominally approached group. Three of the 28 patients had complications requiring open laparotomy. The operating time was 2.7 hours in the 6 retroperitoneal patients and 4.4 hours in the 28 transabdominal patients. Estimated blood loss was 92 ml in the retroperitoneal group and 450 ml in the transabdominal group. The mean postoperative hospital stay was 8 days and 9 days, respectively. These results indicate that the retroperitoneal approach might be preferable in laparoscopic nephrectomy.

Retroperitoneoscopic Radical Nephrectomy by the Posterior Lumber Approach for Renal-Cell Carcinoma Associated with Chronic Renal Failure

“…The retroperitoneal approach was subsequently developed by Gaur and coworkers 11 and has been used by several investigators. 6,[12][13][14] Because the kidney is in the retroperitoneal space, the retroperitoneal approach may decrease the operative time by 20 to 30 minutes compared with the transperitoneal approach. 6,15 An additional advantage of retroperitoneoscopic nephrectomy over the conventional transperitoneal approach is ligation of the renal vessels prior to dissection of the kidney, which is important for preventing hematologic spread of malignant cells.…”

“…However, the efficacy and minimally invasive nature of laparoscopic nephrectomy has been extensively discussed. [1][2][3][4][5][6][11][12][13][14][15] Because our cases were patients with CRF maintained on hemodialysis, the main factor affecting the duration of the hospital stay may not be their postoperative course but the management of their dialysis or treatment of disorders associated with renal insufficiency. Therefore, in order to evaluate the invasiveness of the present procedure, we utilized factors that estimate the catabolic status of patients with chronic renal failure.…”

Retroperitoneoscopic nephrectomy: current status

“…Ono et al compared six RPNs with 32 TPNs and found a shorter operative time and less blood loss with RPN. 32 There were three conversions in the TPN group and none in the RPN group. Further comparisons by Guillonneau et al 33 and McDougall and Clayman 34 revealed similar blood loss, complication rates and hospital stay between RPN and TPN.…”

An update on experience with the single‐instrument port laparoscopic nephrectomy

“…It avoids the risk of injury to intra-abdominal organs and enables quicker recovery [11]. It also facilitates easy positioning of the patient and direct access to the kidney, resulting in a faster operation [12,13]. The kidney falls anteriomedially with gravity, exposing the hilum with minimal dissection and retraction.…”