Retroperitoneoscopic nephrectomy with a modified hand-assisted approach.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Techniques

Background:

• Retroperitoneoscopic (RP) nephrectomy offers advantages like direct renal artery access and avoidance of intraperitoneal organ manipulation.
• The transperitoneal approach is more common due to the perceived steeper learning curve of RP techniques.
• Hand-assistance may mitigate the learning curve by providing tactile feedback and mimicking open surgery.

Purpose of the Study:

• To present the initial experience with a 3-port hand-assisted retroperitoneoscopic (HARP) technique for various nephrectomy procedures.
• To evaluate the safety, efficacy, and applicability of HARP nephrectomy.

Main Methods:

• A total of 133 HARP nephrectomies were performed over four years, including radical nephrectomies, radical nephroureterectomies, and donor nephrectomies.
• The technique utilizes a 7-cm muscle-sparing Gibson incision for the hand-port and two endoscopic ports.
• Patient demographics included a mean age of 62 years, BMI of 30, and 42% with prior abdominal scars.

Main Results:

• Mean operative time was 109 minutes with an average blood loss of 167 mL.
• Average hospitalization was 3.8 days, with a low open conversion rate of 1.5%.
• Complication rates were low, including 3.8% for blood transfusion, 3.8% for cardiac issues, 1.5% for pulmonary embolism, 2.3% for wound infection, and 1.5% for urinary retention.

Conclusions:

• HARP nephrectomy is a safe, effective, and expeditious surgical approach.
• The technique is versatile, suitable for both neoplastic and non-neoplastic kidney conditions.
• HARP provides a minimally invasive alternative, particularly for complex simple nephrectomies, reducing the need for open conversion.