Transperitoneal vs. Retroperitoneal Approach in Laparoscopic Partial Nephrectomy for Posterior Renal Tumors: A
Gonçalo Mendes1, Mariana Madanelo1, Fernando Vila2
1Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal.
Journal of Clinical Medicine
|February 10, 2024
Summary
Laparoscopic transperitoneal partial nephrectomy (LTPN) offers shorter warm ischemia time and better immediate kidney function compared to laparoscopic retroperitoneal partial nephrectomy (LRPN). However, LRPN shows less blood loss, with both approaches yielding similar overall surgical success for posterior renal tumors.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Oncology
Background:
- Partial nephrectomy is the gold standard for small renal masses.
- Laparoscopic approaches, transperitoneal (LTPN) and retroperitoneal (LRPN), are commonly used for posterior renal tumors.
- Comparative data on outcomes between LTPN and LRPN for posterior tumors are limited.
Purpose of the Study:
- To compare perioperative, functional, and oncological outcomes of LTPN versus LRPN.
- To evaluate the efficacy of both laparoscopic approaches for posterior cT1 renal tumors.
Main Methods:
- Retrospective analysis of 128 patients undergoing LTPN or LRPN for posterior cT1 renal tumors (Jan 2015 - Jan 2023).
- Inclusion criteria: single, unilateral, cT1 renal mass in the posterior renal surface.
- Comparison of warm ischemia time (WIT), estimated blood loss (EBL), postoperative estimated glomerular filtration rate (eGFR) drop, positive surgical margin (PSM) rates, and Trifecta success.
Main Results:
- LTPN demonstrated significantly shorter WIT (18.8 vs. 22.6 min) and a smaller immediate postoperative eGFR drop (-6.1 vs. -13.0 mL/min/1.73 m²).
- LRPN showed significantly lower EBL (100 vs. 150 mL).
- PSM rates were lower in LRPN (7.2% vs. 13.5%), though not statistically significant. Overall Trifecta success was similar between groups.
Conclusions:
- LTPN offers advantages in reduced WIT and better immediate renal function preservation for posterior renal tumors.
- LRPN is associated with significantly less blood loss.
- Both LTPN and LRPN achieve comparable overall surgical success (Trifecta) for posterior cT1 renal tumors.
