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Laparoscopic radical nephrectomy: the Nagoya experience
1Department of Urology, Komaki Shimin Hospital, Okazaki City Hospital, Komaki-shi, Japan.
Purpose:
We evaluated the efficacy of laparoscopic radical nephrectomy for removing kidneys with small volume renal cell carcinoma.
Materials And Methods:
25 patients (19 men and 6 women, mean age 59) who had a kidney with small volume renal cell carcinoma (diameter less than 5 cm.), underwent laparoscopic radical nephrectomy. The kidney was dissected laparoscopically together with the adrenal gland, perirenal fatty tissue and Gerota's fascia. In 11 patients, we used the transperitoneal approach and in the remaining 14 we used the retroperitoneal approach, in which a working space is created by finger and balloon dissection. We maneuvered the kidney into the laparoscopy sack, which was then removed through an additional 5 to 6 cm. incision.
Results:
All 25 kidneys were removed successfully. Mean operation time was 5.3 hours and mean estimated blood loss was 335 ml. There were 5 complications, including a patient who suffered an injury to the duodenum, which was treated by open duodenojejunostomy. Full convalescence occurred at an average 23 days. No metastatic disease, no local recurrence and no seeding at the port sites occurred during the followup of 7 to 49 months (mean, 22 months).
Conclusions:
Laparoscopic radical nephrectomy is recommended as a minimally invasive procedure for removing kidneys with small volume renal cell carcinoma.
Insights
Laparoscopic radical nephrectomy effectively removes small renal cell carcinomas. This minimally invasive approach offers a safe and efficient option for kidney cancer treatment with good patient recovery.
Area of Science:
- Urology
- Surgical Oncology
Background:
- Small volume renal cell carcinoma (RCC) presents a growing clinical challenge.
- Minimally invasive surgical techniques are increasingly preferred for RCC management.
Purpose of the Study:
- To evaluate the efficacy of laparoscopic radical nephrectomy (LRN) for small volume RCC.
- To assess the safety and outcomes of LRN in a cohort of patients with small RCC.
Main Methods:
- A cohort of 25 patients with small RCC (diameter < 5 cm) underwent LRN.
- Both transperitoneal (11 patients) and retroperitoneal (14 patients) approaches were utilized.
- Surgical dissection included the kidney, adrenal gland, perirenal fat, and Gerota's fascia.
Main Results:
- Successful nephrectomy was achieved in all 25 cases.
- Mean operative time was 5.3 hours with an average blood loss of 335 ml.
- No port site seeding or local recurrence was observed during a mean follow-up of 22 months, though 5 complications occurred.
Conclusions:
- LRN is a recommended minimally invasive procedure for small volume RCC.
- The technique demonstrates favorable oncological outcomes and acceptable complication rates.
- LRN facilitates efficient kidney removal with good patient convalescence.