Simple nephrectomy: retroperitoneal approach

Direct extraperitoneal surgery has become the preferred approach to laparoscopic nephrectomy since the introduction of the balloon dilation method. The lateral decubitus position provides good exposure, but the prone position is used at some centers to gain better exposure with the aid of gravity. The open conversion rate ranges from 0 to 16% and the complication rate from 5% to 45%, with most complications being minor. Retroperitoneal laparoscopic simple nephrectomy is definitely superior to open nephrectomy as judged by analgesic use and recovery time. The higher complication rate and lower efficiency can be taken care of by experience and proper case selection.