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Laparoscopic radical nephrectomy: retroperitoneal versus transperitoneal approach.
Surena F Matin1, Inderbir S Gill
1Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, OH 44195, USA.
Current Urology Reports
|June 27, 2002
Summary
Transperitoneal and retroperitoneal laparoscopic radical nephrectomy are effective. Surgeon experience historically dictated approach choice, but both methods uphold oncologic principles for kidney cancer surgery.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic radical nephrectomy is a standard treatment for kidney cancer.
- Two primary laparoscopic approaches exist: transperitoneal and retroperitoneal.
- Surgeon preference and training have traditionally guided approach selection.
Purpose of the Study:
- To review the history, indications, and techniques of transperitoneal and retroperitoneal laparoscopic radical nephrectomy.
- To summarize global experience and discuss controversial aspects of specimen handling.
Main Methods:
- Review of existing literature on laparoscopic radical nephrectomy approaches.
- Discussion of surgical principles, patient preparation, and anatomical considerations.
- Synopsis of worldwide surgical outcomes and specimen extraction debates.
Main Results:
- Both transperitoneal and retroperitoneal laparoscopic approaches are oncologically sound.
- Key surgical principles include wide mobilization and early vascular control.
- Controversies exist regarding specimen morcellation versus intact extraction.
Conclusions:
- Laparoscopic radical nephrectomy can be performed effectively via either approach.
- Adherence to oncologic principles is paramount regardless of the chosen technique.
- Further discussion is warranted on optimal specimen handling strategies.