Transperitoneal versus retroperitoneal laparoscopic radical nephrectomy: A comparative study

Abstract

Objectives:To compare perioperative outcome of transperitoneal and retroperitoneal approaches during laparoscopic radical nephrectomy (LRN) and to identify selection criteria for each approach. Methods: Over a 7-year period , 100 consecutive patients (median age 62 years, range 20-80) underwent LRN for a renal tumor with clinical stage T1a-T3a. The first choice approach was retroperitoneal. The transperitoneal approach was chosen in selected cases based on tumor characteristics. Thirty-three patients underwent the transperitoneal approach, and 67 had the retroperitoneal approach. Perioperative parameters including operative time, blood loss and complications and pathology data were retrospectively analyzed. Results: Overall, 33 transperitoneal laparoscopic radical nephrectomies (TLRN) and 67 retroperitoneal laparoscopic radical nephrectomies (RLRN) were carried out. There was a statistically significant difference between the two groups in terms of size (5.3 vs 3.0 cm, P < 0.0001) and clinical T stage (higher in the TLRN group, P < 0.0001) of the tumors. Intraoperative complications included bradycardia, pneumothorax, renal vein injury, and renal artery injury in the TLRN group, and pneumothorax in the RLRN group. There were no differences in terms of operative time, blood loss and tumor grade between the two groups. Conclusions: Retroperitoneal and transperitoneal approaches yielded excellent surgical outcomes. The transperitoneal approach should be chosen based on tumor size and location to minimize vascular injury.

Retroperitoneoscopic nephrectomy has better perioperative outcomes than transperitoneal laparoscopic nephrectomy in obese patients

“…A comparison of RN and TLN obtained from the literature is detailed in Table 6. [26][27][28][29][30][31][32] Generally, there were no significant differences between the two techniques with respect to perioperative parameters (including OT, EBL and LHS). However, a tendency toward increased complications and higher open conversion Table 2 Group rates has been reported with TLN.…”

A modified adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy

“…However, the procedure of retroperitoneoscopic surgery, where the main step is the management of the renal pedicle and the adrenal gland, is controversial and needs to improve [24,25]. During the surgery, adrenal gland-sparing is necessary in many cases, such as when tumors are located in the lower-middle part of the kidney, and for small RCC and renal pelvic tumors [26]. Although adrenal gland-sparing is easier than adrenalectomy, lacerations of the adrenal gland usually occurred due to the complex inner structure and even led to wound errhysis or delayed hemorrhage [27].…”

Complications of laparoscopic renal surgery

“…Table 2 outlines the advantages and disadvantages of each approach and has been adopted from a recent retrospective review comparing each approach 50 . In short the retroperitoneal approach provides easier access to the renal artery, and a lower risk of injury to adjacent abdominal organs, however this is at the cost of fewer landmarks, and a smaller operating space.…”

“…49 Table 2 outlines the advantages and disadvantages of each approach and has been adopted from a recent retrospective review comparing each approach. 50 In short the retroperitoneal approach provides easier access to the renal artery, and a lower risk of injury to adjacent abdominal organs, however this is at the cost of fewer landmarks, and a smaller operating space. Taue recommends the retroperitoneal approach for patients with a history of previous abdominal surgery and peritoneal dialysis and a transperitoneal approach for larger tumors (T2 or greater), particularly those that may have a more posterior location.…”