Transperitoneal laparoscopic radical nephrectomy
Abstract
Background: Our purpose was to present our experiences with transperitoneal laparoscopic radical nephrectomy in patients with renal cancer and to compare our results with those published in the literature.
Patients and methods: Between June 2000 and March 2006 in 11 patients with age range 39 to 82 years (mean 56.3 years) in whom the renal cancer was found, we tried to do transperitoneal laparoscopic radical nephrectomy. For diagnosis of renal cancer abdominal ultrasound, CT scan, chest X-ray, blood and urine tests were done. During operative procedures we measured the operating time and blood loss. After procedure we registered analgesics needs of patients, hospital stay and patient’s return to normal activity. In all cases pathological examination of the specimen was done.
Results: Laparoscopic procedure was performed entirely in 8 patients. We have to reoperate 1 patient on second day after the first procedure because of the bleeding caused by blood coagulation disturbances. In 3 patients conversion into classical technique was necessary (major bleeding or technical difficulties). In 2 patients among 8 cases we finished the laparoscopic procedure using the hand-assisted technique. All patients had a renal cell carcinoma, 4 patients (50 %) in stage pT1, 2 (25 %) in stage pT2 and 2 (25 %) in stage pT3. The mean operating time was 209 minutes. Two patients were transfused with packed red cells. Analgesics were in all patients necessary on the day of operating procedure and the day after. The postoperative hospitalization range was 4 to 7 days. The patients began with normal physical activity 5 to 15 day after surgery.
Conclusions: Our initial results with transperitoneal laparoscopic radical nephrectomy are comparable with those published in the literature. We believe that use of proper vascular staplers, other needful instruments and more experiences can significantly reduce the operating time.
Downloads
References
O’Brien WM, Lynch JH. Adrenal metastases by renal cell carcinoma. Incidence at nephrectomy. Urology 1987; 29: 605–7.
Kozak W, Holtl W, Pummer K, Maier U, Jeschke K, Bucher A. Adrenalectomy-still a must in radical renal surgery? Br J Urol 1996; 77: 27–31.
Von Knobloch R, Seseke F, Riedmiller H, Grone HJ, Walthers EM, Kalble T. Radical nephrectomy for renal cell carcinoma: is adrenalectomy necessary? Eur Urol 1999; 36: 303–8.
Angervall L, Wahlquist L. Follow-up and prognosis of renal carcinoma in a series operated by perifascial nephrectomy combined with adrenalectomy and retroperitoneal lymphadenectomy. Eur Urol 1978; 4: 13–7.
Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embiolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma. Am J Clin Oncol 2000; 23: 6–12.
Robson CJ. Radical nephrectomy for renal cell carcinoma. J Urol 1963; 89: 37.
Clayman RV, Kavaoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991; 146: 278.
Portis AJ, Clayman RV. Should laparoscopy be the standard approach used for radical nephrectomy? Curr Urol Rep 2001; 2: 165–70.
Ljungberg B, Hanbury DC, Kuczyk MA, Merseburger AS, Mulders PFA, Patard JJ, et al. EAU Guidelines on renal cell carcinoma, 2006.
Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O, Ohshima S. The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol 2001; 165: 1867–70.
Rassweiler J, Taivan A, Kumar AV, Lymberakis C, Schulze M, Seeman O, et al. Oncological safety of laparoscopic surgery for urological malignancy: experience with more than 1000 operations. J Urol 2003; 169: 2072–5.
Wille AH, Roigas J, Deger S, Tullman M, Turk I, Loening SA. Laparoscopic radical nephrectomy: techniques, results and oncological outcome in 125 consecutive cases. Eur Urol 2004; 45: 483– 8.
Zupančič M, Kramer F, Vodopija N. Laparoskopska kirurgija pri raku ledvice – 9. slovenski urološki simpozij v sodelovanju z ESU Rak ledvice; 2003 Maj 22-23; Velenje, Slovenija. Slovenj Gradec: Urološki oddelek, Splošna bolnišnica; 2003.
Janetschek G, Al-Zahrani H, Vrabec G, Leeb K. Laparoscopic tumor nephrectomy in German. Urologe A 2002; 41: 101–6.
Stifelman MD, Sosa RE, Shichman SJ. Hand-asisted laparoscopy in urology. Rev Urol 2001; 3: 63–71.
Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, et al. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol 2000; 164: 1153–9.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
