[Technique of renal pedicle control in transperitoneal laparoscopic nephrectomy: experience of 191 cases by a single
Lei Zhang1, Lin Yao1, Xue-song Li1
1Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
Objective:
To explore the technique of vascular control in transperitoneal laparoscopic nephrectomy.
Methods:
From May 2010 to September 2013, 191 consecutive transperitoneal laparoscopic nephrectomies were performed by a single surgeon. The operations included 116 radical nephrectomies, 57 nephroureterectomies, and 18 simple nephrectomies. Improved 4-trocar method was applied. Through lifting up inferior pole of the kidney by an assistant, and observing renal vascular from the bottom or back of the kidney, the exposure of renal vessels were improved. The renal vessels were managed with Hem-o-lock or Endo GIA. For tumors of stage ≥ T2, ipsilateral lymph node dissection of renal hilus was performed.
Results:
Of the entire 191 cases,190 were performed successfully, only 1 converted to open surgery because of the difficulty in separating the tumor from the invaded colon. The average time of operation was 171.5 min (74-352). The blood loss was 5-1 000 mL with an average of 94.8 mL. The complications included vascular injuries (5 cases), cerebral infarction accompanied by acute renal injury (1 case), and pulmonary infection (2 cases). The mean postoperative hospital stay was 5.6 days (2-19 days). No perioperative death occurred.
Conclusion:
The reformative technique of vascular control could improve the exposure of renal vessels, increase surgery safety, and shorten the time of transperitoneal laparoscopic nephrectomy.
