Laparoscopic partial nephrectomy: is it worth still performing the retroperitoneal route?

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Laparoscopic partial nephrectomy (LPN) is a standard treatment for small renal masses.
• Transperitoneal (TLPN) and retroperitoneal (RLPN) approaches are common methods for performing LPN.
• Direct comparison of perioperative, oncologic, and functional outcomes between TLPN and RLPN is crucial for surgical decision-making.

Purpose of the Study:

• To compare perioperative, oncologic, and functional outcomes of transperitoneal laparoscopic partial nephrectomy (TLPN) versus retroperitoneal laparoscopic partial nephrectomy (RLPN).

Main Methods:

• A retrospective study of 153 patients who underwent TLPN or RLPN for suspicious renal masses between 1997 and 2009.
• Comparison of complication rates, functional outcomes (including chronic kidney failure), and oncologic outcomes (recurrence-free survival).

Main Results:

• Mean operative time and hospital stay were significantly longer for TLPN compared to RLPN.
• Rates of transfusion and urinary fistulas were similar between the two groups.
• Mid-term (3-year) functional outcomes (chronic kidney failure rates) and oncologic outcomes (recurrence-free survival) were comparable for TLPN and RLPN.

Conclusions:

• Transperitoneal laparoscopic partial nephrectomy (TLPN) is associated with longer operative time and hospital stay than retroperitoneal laparoscopic partial nephrectomy (RLPN).
• Both TLPN and RLPN demonstrate similar complication rates and mid-term oncologic and functional outcomes.
• The choice between TLPN and RLPN may depend on surgeon preference and specific tumor characteristics, as outcomes are comparable.