Purpose: Laparoscopic radical nephrectomy is preferentially performed by transperitoneal approach. Despite offering advantages the direct retroperitoneal laparoscopic approach has not found uniform acceptance due to small working space in the retroperitoneum. Retroperitoneoscopy is our preferred approach for performing radical nephrectomy for localized renal tumors. We present our technique and our experience with the first 50 retroperitoneoscopic radical nephrectomies and compare the results with other series.
Materials and methods: 50 patients underwent retroperitoneoscopic radical nephrectomy for renal tumors cT1/cT2 between march 2004 to march 2007. A four ports retroperitoneal laparoscopic nephrectomy technique is performed with the patient in the full flank position. An artisanal balloon is used to create the retroperitoneal working space. The specimen is extracted intact by an extraperitoneal iliac incision. Follow up data were retrospectively reviewed.
Results: Mean tumor size was 5.3 cm (3 to 13 cm), surgical time was 150 min (90 to 300 min), and blood loss was 130 ml (40-1000 ml). Average hospital stay was 2.2 days (1-11 days). Complications occurred in 6 (12%) patients. Two patients (4%) presented major complications and one of then require open conversion. Four patients (8%) presented minor complications. There were two later recurrences. One local and port site recurrence in a pT3aN0M0 renal cancer and one systemic metastases in a pT3N0M0 urothelial cancer occurred. Both cases presented inadequately extraction.
Conclusion: Retroperitoneoscopy is a feasible, effective and safe alternative for the treatment of localized renal tumors. Retroperitoneoscopy should be avoided in advanced and large size renal tumors.