Laparoscopic Radical Nephrectomy – The Cohort of 150 Patients

Overview

Background.
Minimally invasive surgery has been performing in the treatment of renal cancer at the Department of Urology in Plzeň since January 2003. We want to present and evaluate our results of laparoscopic nephrectomy (LRN) in the cohort of 150 patients. 

Methods and Results.
In our institution, 150 LRNs were performed in the period between January 2003 and April 2007, 145 of them transperitoneally and 5 retroperitoneally. These 150 LRNs were completed by 4 different surgeons. We use four trocars in a rhombus disposition for left-sided LRN, we add fifth port for liver elevation for right-sided LRN. We place four ports for retroperitoneoscopical LRN. Renal vessels are sectioned either separately with lockable clips or with endoGIA stapler en bloc. After mobilization of the kidney, it is inserted into the endobag and extracted through the extended incision after the 12 mm port in lower abdomen using splitting incision. 73 right and 77 left LRN were performed in our patients cohort. The mean age of patients was 62.5±10.2 (range 33.9–84.6) years. The mean operation time was 138±44 (55–270) minutes. The mean size on CT was 54.3±15.1 (29–101) mm. The mean hospitalization time was 6.1±2 (3–15) days. Adrenalectomy was performed in 16 patients, cholecystectomy in 4 patients and appendectomy in 3 patients. Per- operative complications appeared in 5 cases (3 %). Post- operative complications appeared in 7 patients (5 %). We can not evaluate own oncological results because of short-time follow-up. 

Conclusions:
LRN has become a new gold standard in the treatment of kidney tumours T1 (to 7 cm) and it represents an important approach in the treatment of kidney tumours in our institution. We highly recommend preoperatively biphasic CT angiography because it shows the exact number and topography of renal vessels. We prefer transperitoneal approach because of the larger working space and better topographical orientation. Patients profit from advantages of miniinvasivity mainly due to the faster return to the normal life. To the main disadvantages of this technique belong the higher technical demands on the operator and a higher prize of the procedure compared to the open operation. 

Key words:
renal cancer, minimally invasive surgical procedure, laparoscopy, nephrectomy.