Laparoscopic Radical Nephrectomy

Allan, James D.D.; Tolley, David A.; Kaouk, Jihad; Novick, Andrew C.; Gill, Inderbir S.

doi:10.1159/000049744

Cited by 60 publications

(25 citation statements)

References 66 publications

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“…The main advantages of the retroperitoneoscopic technique are the absence of intra abdominal manipulation, therefore reducing the chance of iatrogenic lesions of the intra-peritoneal organs (3,4,8,9), and the direct access to the renal pedicle allowing early control of the renal artery and vein (3,9). In our series we obtained faster access to the renal pedicle with RRN than with HALRN.…”

Section: Commentsmentioning

confidence: 54%

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Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

Tobias-Machado¹,

Ravizzini²,

Pertusier³

et al. 2009

Int. braz j urol.

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Objective: No consensus has yet been established regarding the best minimally invasive access for radical ablation of renal tumors. Our objective was to prospectively compare the surgical results and oncologic management of two currently used endoscopic techniques. Materials and Methods: Over a four-year period, 50 patients with renal tumors and clinical stage T1b-T2, smaller than 12 cm, underwent a radical nephrectomy at two reference institutions, 25 underwent retroperitoneoscopic radical nephrectomy (RRN) and 25 a hand-assisted laparoscopic radical nephrectomy (HALRN). Mean follow-up of both cohorts was 50 months. Operative parameters and oncological management were compared. Results: The mean operative time was 180 min in RRN and 108 min in HALRN (p < 0.001). The time required to access the renal pedicle in RRN was 30 min. and in HALRN 40 min., Learning curve was shorter in HALRN than RRN. Mean blood loss was 100 mL in RRN and 242 mL in HALRN. Mean incision size for specimen retrieval in RRN was 6.5 cm and in HALRN 7.5 cm. One patient with intra operative occurrence of ascites and subsequent pathological stage pT2N0M0 grade 3 operated via HALRN, had neoplasic implants in the Hand-port incision 3 months after surgery followed by death 4 months after recurrence. One patient, with pathological stage pT3N0M0 grade 3 in RRN had metastasis after 36 months. Conclusion: Both, RRN and HALRN techniques are accepted minimally invasive options for endoscopic radical nephrectomy with equivalent long term oncological outcome in the treatment of renal tumors.

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Section: Commentsmentioning

confidence: 54%

“…Laparoscopic radical nephrectomy has been accepted as a treatment of choice for renal tumors with stage T1-T2 smaller than 8 cm when radical surgery is indicated (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

Tobias-Machado¹,

Ravizzini²,

Pertusier³

et al. 2009

Int. braz j urol.

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“…Birçok seride LRN'nin açık cerrahiye göre daha az kan kaybına neden olduğu, hastaların daha az ağrı kesiciye gereksinim duyduğu, bağırsak aktivitelerinin daha çabuk geri döndüğü, hastanede yatış sürelerinin daha kısa olduğu, yara infeksiyon oranlarının daha az olduğu, iyileşmenin daha çabuk ve kozmetiğin daha iyi olduğu gösterilmiştir [25][26][27]. Ameliyat sırasında hiçbir hastaya kan transfüzyonu yapılmadı, ancak post operatif dönemde 2 (%5,2) hastada hematokrit düşüklüğü sebebiyle iki hastaya 2 ünite ve altı hastaya 1 ünite olmak üzere 8 ünite eritrosit süspansiyonu verildi.…”

Section: Discussionunclassified

Our laparoscopic radical nephrectomy experiences

Dağgülli¹

2014

Diclemedj

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Objective: In this study our aim is to present outcomes of laparoscopic radical nephrectomy (LRN) we have been applying for the management of renal masses. Methods:We retrospectively examined medical files of 54 cases who underwent LRN in the Urology Clinics of Dicle University between October 2010, and April 2014. Archival files of the patients were retrospectively analyzed as for age, gender, obesity, dimensions, and laterality of renal mass, smoking status, history of hypertension, histopathology results, blood transfusion (if any), hospital stays, peri-and post-operative complications, drain removal times, and method of removal of the nephrectomy material.Results: Our study population (n=54) consisted of 21 male, and 33 female patients with a mean age of 58,8 (29-82) years. Some of them were smoker (n=23), hypertensive (n=15), and obese (n=32) patients. Renal masses with a median diameter of 6.2 cm (4,5-16,5) were localized in the right (n=23) or left (n=31) kidneys. In all cases, transperitoneal approach was preferred. In 3 cases we have to switch to an open surgery. In 8 patients, blood transfusions were required. In 18 patients 4th port was used for the retraction of the liver, while in other cases only 3 ports were used. Median operative time was 115.6 min . Median hospital stay was 3,9 days (3-16). In one case abundant bleeding occurred because of splenic artery injury. Conclusion:Transperitoneal LRN is a minimally invasive surgical method which can be performed rapidly, and effectively. We think that in procedures performed in compliance with surgical principles, LRN can be realized safely with lower complication rates even by urologists in their initial experiences. On sekiz hastada, karaciğer ekartasyonu için 4. port kullanılırken, diğer tüm vakalarda 3 port kullanıldı. Ortalama operasyon süresi 115,6 dk (75-192) idi. Ortalama hastanede kalış süresi 3,9 gün (3-16) idi. 1 olguda splenik arter yaralanmasına bağlı abondan kanama gelişti.Sonuç: Transperitoneal LRN, hızlı ve etkin bir şekilde yapılabilen minimal invaziv bir cerrahi yöntemdir. Laparoskopik cerrahi prensiplere bağlı kalarak yapılan cerrahi işlemlerde başlangıç deneyimlerde bile LRN düşük komplikasyon oranları ile güvenle yapılabilecek bir cerrahi olduğunu düşünmekteyiz.

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“…Interestingly, retroperitoneal LRN for T1 RCC offered several advantages, with statistical differences from open surgery. Reports worldwide confirm the benefits of this less invasive procedure and comparisons between LRN and open RN have consistently shown advantages for the former approach in all indices of perioperative morbidity, including estimated blood loss, postoperative narcotic requirement, length of hospitalization and duration of convalescence [6,7,[11][12][13][14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy

et al. 2003

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recurrence, were compared between the groups. RESULTSThere were no differences between the laparoscopic and open groups in age, sex ratio, weight, height, fitness score, operative duration (134 vs 133 min), minor or major complications, tumour diameter, Fuhrman grade or length of follow-up. Patients who underwent laparoscopic surgery had less blood loss (133 vs 357 mL, P < 0.001), less need for transfusion (none vs 150 mL, P = 0.04), a lower consumption of analgesia drugs, and shorter hospitalization (5.5 vs 8.8 days, P < 0.001). With a mean follow-up of 20.4 months there was no recurrence or tumour progression. CONCLUSIONLaparoscopic radical nephrectomy for patients with T1 renal cancer is a safe, reliable procedure that decreases hospitalization time and bleeding, and ensures the same cancer control as open nephrectomy.

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Laparoscopic Radical Nephrectomy

Cited by 60 publications

References 66 publications

Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

Our laparoscopic radical nephrectomy experiences

Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy

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