Retroperitoneoscopic partial nephrectomy for renal cell carcinoma: A single-center Indian experience

Retroperitoneoscopy, by avoiding peritoneal breach and injury to intra-abdominal organs, provides a more direct and rapid access to the kidney and the renal hilum. Laparoscopic partial nephrectomy by retroperitoneal route (LPNR) is less commonly performed than transperitoneal route for early stage renal cancer. The objective of this study is to carry out the outcomes of partial nephrectomy using retroperitoneal approach.

Patients, who underwent LPNR from period 2008 to 2014, were retrospectively analyzed. Outcomes of interest included demographic data, preoperative data, perioperative variables, surgical complications, recurrence of disease, and mortality, if any, during their follow-up.

Among 24 patients, 16 were male, and 8 were female. Mean age and mean body mass index, respectively, were 49.16 years (range: 25-75) and 25.35 kg/m² (17.84-34.25). Among renal masses, the right-sided to left-sided distribution was 13:11. The proportions of low-risk and intermediate-risk nephrometry score (NS) cases were 13 (54.17%) and 11 (45.83%), respectively, as assessed by renal NS. Mean operative duration, mean warm ischemia time, mean estimated blood loss, and mean hospital stay, respectively, were 132.5 min (90-170), 21.83 min (15-44), 106 ml (25-300) ml, and 5.25 days. During the postoperative period, complications encountered were lung atelectasis in one, bleeding in two, and urinary leakage in one. Histopathology revealed malignancy in 23 patients and leiomyoma in the remaining one. All patients but two experienced a disease free survival during a median follow- up period of 33 months.

Overall outcomes for LPNR is comparable to the outcomes for open and transperitoneal laparoscopic partial nephrectomy mentioned in the literature and is equally safe for the right-sided and left-sided lesions.