Hétet Jean-François, Rigaud Jérôme, Renaudin Karine, Battisti Simon, Braud Guillaume, Bouchot Olivier, Karam Georges
Clinique Urologique, CHU Hôtel-Dieu, Nantes, France.
Prog Urol. 2005 Feb;15(1):10-7; discussion 16.
To analyse the results of laparoscopic retroperitoneal radical nephrectomy in terms of feasibility, morbidity and disease control.
Between October 1997 and May 2004, 42 laparoscopic retroperitoneal radical nephrectomies were performed in 33 men and 9 women for renal tumour. Three or four trocars were used depending on the operative findings in order to achieve oncological imperatives: primary control of the renal pedicle before mobilization of the kidney (the artery was clipped and the vein was sectioned by Endo-GIA), passage in the plane of radical nephrectomy and absence of direct contact with the tumour The operative specimen was extracted whole in an impermeable endoscopic bag by enlarging a trocar orifice to avoid any parietal contact.
21 right radical nephrectomies and 21 left radical nephrectomies were performed in patients with a mean age of 61.8 years (range: 36 to 83 years). The mean size of the kidney was 120 mm (range: 60 to 170 mm), for a mean weight of 430 g (range: 55 to 870 g). The mean tumour size was 46.4 mm (range: 15 to 90 mm). The mean operating time was 132 min (range: 70 to 240 mm) for an estimated mean blood loss of 120 cc (range: 0 to 1000 cc). The mean hospital stay was 8.3 days (range: 4 to 26 days). Conversion was necessary for technical difficulties in 7 cases (16.7%), venous injuries in 5 cases, arterial injury in 1 case, and difficult dissection of the perirenal fat due to a history of high-grade diffuse lymphoma in remission. The final histological stage showed 31 pT1 tumours, one pT2 tumour and 10 pT3 tumours. Four patients died in a context of metastatic diseases with a mean follow-up for our series of 15 months (range: 1 to 64 months).
Laparoscopic retroperitoneal radical nephrectomy is a feasible technique, which strictly complies with the principles of cancer surgery. The main complication observed in our series was bleeding, which appears to depend on the surgeon's experience.
