Retroperitoneoscopic nephrectomy: current status

Abstract

The classic retroperitoneal open surgical access to the kidney has been duplicated while performing laparoscopy but is less common than transperitoneal laparoscopy. We reviewed minimally invasive retroperitoneoscopic nephrectomy as a part of the international consultation on urological diseases and European Association of Urology international consultation on minimally invasive surgery in urology. A Pubmed/Medline search was performed to identify studies assessing the feasibility, safety and efficacy of laparoscopic and robotic retroperitoneoscopic nephrectomy. The articles were reviewed to assess outcomes after simple, radical and donor nephrectomy and comparative trials between retroperitoneoscopic versus the open and transperitoneal route were evaluated. Retroperitoneoscopic nephrectomy is feasible for most cases of benign non-functioning kidneys. Retroperitoneoscopic radical nephrectomy is also feasible for most tumours and may be better suited for posteriorly located tumours. Both retroperitoneoscopic and transperitoneal nephrectomy have similar outcomes but the operative time may be shorter for the former. The data are insufficient for robotic retroperitoneoscopic nephrectomy probably because of limited space and lack of benefit of a robot in ablative surgeries. Level of evidence: 3a

Introducing robot‐assisted laparoscopic donor nephrectomy after experience in retroperitoneal endoscopic approach: a matched propensity score analysis

“…Moreover, there were no significant differences in postoperative renal function and haemoglobin drop between the two donor groups. This finding is consistent with previous literature reports on the safety of the new technique of RALDN 8,9,17–19 . Moreover, the studies suggested that robotic surgery has some advantages compared with laparoscopic surgery regarding surgical ease in renal hilar dissection and reduction of donor morbidity 20,21 …”

“…Previous studies showed an equal or a shorter mean hospital stay in the RALDN group. 5,17,22,26 In our study, there were no significant differences in serum creatinine at 1 month after transplantation between the two groups of respective recipients. There were no cases of slow graft function and delayed graft function during the follow-up interval.…”

“…Therefore, in our study, the drain withdrawal time was the better indicator for fit for discharge; and there was no significant difference in drain withdrawal time between the two groups. Previous studies showed an equal or a shorter mean hospital stay in the RALDN group 5,17,22,26 …”

“…This finding is consistent with previous literature reports on the safety of the new technique of RALDN. 8,9,[17][18][19] Moreover, the studies suggested that robotic surgery has some advantages compared with laparoscopic surgery regarding surgical ease in renal hilar dissection and reduction of donor morbidity. 20,21 In our cohort, similar to the comparative study published by Bhattu et al 22 the opioid analgesic requirement in RALDN group was less than those in REDN group.…”

“…In comparison, we believed the retroperitoneal robotic living nephrectomy would be a more challenging option, with fewer reported experience, due to the limited working space which can result in increased clashing of the robotic arms and difficulty to access the kidney rapidly after the renal vessels are clamped and divided. 17 Currently, both REDN and RALDN techniques are both offered at our institution. The above study showed that RALDN could be safely introduced into a living donor kidney transplant program routinely performing REDN.…”