Laparoscopic radical nephrectomy: retroperitoneal versus transperitoneal approach

Laparoscopic radical nephrectomy can be efficaciously performed by either the transperitoneal or the retroperitoneal laparoscopic approach. The primary indication for selecting one approach over another has historically depended on the individual surgeon's experience and training. With either technique, laparoscopy adheres to established surgical oncologic principles of wide specimen mobilization and early vascular control. This article reviews the history, contraindications, anatomic considerations, patient preparation, and surgical technique of these two laparoscopic approaches. A salient summary of the worldwide experience with these procedures is presented, as well as a brief synopsis of controversial arguments favoring specimen morcellation versus intact extraction.