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[Laparoscopic radical nephrectomy--the cohort of 150 patients]
Background:
Minimally invasive surgery has been performing in the treatment of renal cancer at the Department of Urology in Plzen since January 2003. We want to present and evaluate our results of laparoscopic nephrectomy (LRN) in the cohort of 150 patients.
Methods And Results:
In our institution, 150 LRNs were performed in the period between January 2003 and April 2007, 145 of them transperitoneally and 5 retroperitoneally. These 150 LRNs were completed by 4 different surgeons. We use four trocars in a rhombus disposition for left-sided LRN, we add fifth port for liver elevation for right-sided LRN. We place four ports for retroperitoneoscopical LRN. Renal vessels are sectioned either separately with lockable clips or with endoGIA stapler en bloc. After mobilization of the kidney, it is inserted into the endobag and extracted through the extended incision after the 12 mm port in lower abdomen using splitting incision. 73 right and 77 left LRN were performed in our patients cohort. The mean age of patients was 62.5 +/- 10.2 (range 33.9-84.6) years. The mean operation time was 138 +/- 44 (55-270) minutes. The mean size on CT was 54.3 +/- 15.1 (29-101) mm. The mean hospitalization time was 6.1 +/- 2 (3-15) days. Adrenalectomy was performed in 16 patients, cholecystectomy in 4 patients and appendectomy in 3 patients. Per-operative complications appeared in 5 cases (3%). Post-operative complications appeared in 7 patients (5 %). We can not evaluate own oncological results because of short-time follow-up.
Conclusions:
LRN has become a new gold standard in the treatment of kidney tumours T1 (to 7 cm) and it represents an important approach in the treatment of kidney tumours in our institution. We highly recommend preoperatively biphasic CT angiography because it shows the exact number and topography of renal vessels. We prefer transperitoneal approach because of the larger working space and better topographical orientation. Patients profit from advantages of miniinvasivity mainly due to the faster return to the normal life. To the main disadvantages of this technique belong the higher technical demands on the operator and a higher prize of the procedure compared to the open operation.
Insights
Laparoscopic nephrectomy (LRN) is a valuable minimally invasive treatment for renal tumors, offering faster recovery. While technically demanding, LRN is becoming a new standard of care for kidney cancer.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Oncology
Background:
- Minimally invasive surgery for renal cancer has been performed since 2003.
- This study evaluates the outcomes of 150 laparoscopic nephrectomies (LRN).
Purpose of the Study:
- To present and evaluate the results of laparoscopic nephrectomy (LRN) in a cohort of 150 patients.
- To assess the feasibility and outcomes of LRN for renal tumors.
Main Methods:
- 150 LRNs were performed between January 2003 and April 2007, primarily transperitoneally.
- Standardized trocar placement and vessel sealing techniques were utilized.
- Kidney extraction was performed using an endobag through an extended umbilical incision.
Main Results:
- The mean patient age was 62.5 years, with a mean tumor size of 54.3 mm on CT.
- Average operative time was 138 minutes, and mean hospitalization was 6.1 days.
- Peri-operative complications occurred in 3% and post-operative complications in 5% of patients.
Conclusions:
- LRN is a new gold standard for treating T1 renal tumors (up to 7 cm).
- Preoperative CT angiography is recommended for precise renal vessel mapping.
- The transperitoneal approach is preferred for its superior working space and orientation, benefiting patients with faster recovery.
