Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal...

The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery.

We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups.

Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications (p = 0.121). However, operative time (p = 0.003) and length of stay (p < 0.001) were greater in patients with versus those without previous open cholecystectomy.

Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.