[Laparoscopic radical nephrectomy. Analysis of 10 cases and preliminary report of retroperitoneal approach]

To examine the efficacy of laparoscopic radical nephrectomy (LPRNX) for patients with small renal cell carcinoma, the clinical result of 10 patients treated with this procedure was analysed.

Ten patients with renal cell carcinoma measuring diameter less than 5 cm were treated by LPRNX between July 1992 and October 1994. Four cases had T1N0M0 disease and 6 had T2N0M0 disease. Of the 10 patients, seven had right sided tumor and three had left sided tumor.

Trans-abdominal approach was employed for the initial 8 cases. Retroperitoneal approach was applied for the last 2 cases. Five trocars were placed through lateral abdominal wall. Intraperitoneal or retroperitoneal cavity was insffulated with CO2 at 12 mmHg. A kidney was dissected endoscopically with Gerota's fascia, peri renal fatty tissue and adrenal gland as en bloc fashion. It was trapped into the laparoscopy sack and pulled out of the body through a 4 to 5 cm incision without morcellation.

Average operation time was 331 minutes and average bleeding was 380 ml. All the kidneys were removed by endoscopic technique. As major complications, we experienced a cases of splenic injury and a cases of adrenal injury. The bleeding of both cases was successfully managed by endoscopical procedure, however, transfusion was needed for the last case. Pathological examination of specimens revealed renal cell carcinoma in all ten cases. Average hospital stay after surgery was 10.6 days and average duration to the convalescence was 20 days. There was no episode of recurrence in all 10 patients for 2 to 29 months (Mean: 15.2 months) followed up period.

Although further technical progress was expected, LPRNX is a potential operative procedure that realizes minimally invasive therapy for the patients with small volume of renal cell carcinoma.