[Laparoscopic and retroperitoneoscopic resection of the kidney]

The surgeons of the clinic at the chair of endoscopic urology operated 32 patients (18 males, 14 females, age 40-78, mean age 55 +/- 0.8 years) with renal carcinoma (RC) from 2007 to 2010: 31 patients had RC stageT1N0M0, 1 patient--T2N0M0, 12 patients had RC of the right kidney, 19--of the left kidney, bilateral RC was in 1 patient. A laparoscopic transperitoneal approach was used in 14 cases. Indications for such approach were the following: size of the tumor 2.2-4 cm, location of the tumor in the upper anterior segment (n = 13), in the middle segment (n = 1). Ischemia was made in 5 patients. Resection of the kidney via a laparoscopic retroperitoneal approach was made in 11 patients. Indications were the following: size of the tumor 1.1-4 cm, posterior tumor location. Ischemia (17 and 24 min) was used in 2 cases, mean blood loss 118 ml (from 50 to 250 ml). Nine patients were operated with application of YAG:Nd laser (Lazurit) which resected an extraorganic tumor of a small size (1.1-2.2 cm) without ischemia and significant blood loss. Laparoscopic assisted resection of the kidney was performed in 9 cases. Hand assistance was indicated in large tumors (4.3 to 8.9 cm), posterior tumor location (n = 4), upper location (n = 2). One-stage bilateral resection of the kidneys in the middle segment was made in one patient. Hand assistance was also required in one patient for one-stage resection of two tumors of the right kidney. Laparoscopic resection of the kidney is indicated in bilateral tumor, in a single functioning kidney, in affection of the contralateral kidney, or disease with potential contralateral kidney affection. Indications for endovideosurgical methods of treatment need detailed specification and perfection. Choice of one of the above approaches should be based on tumor size and its location.