Silva Quintela R, Siqueira F, Marelli de Carvalho G, Miranda Salim M, Lopes Abelha D, Eduardo Távora J
Servicio de Urología, Hospital da Previdência dos Servidores do Estado de Minas Gerais, Hospital Vila da Serra and Hospital da Baleia, Belo Horizonte, Minas Gerais.
Actas Urol Esp. 2008 Apr;32(4):417-23. doi: 10.1016/s0210-4806(08)73856-7.
Laparoscopic radical nephrectomy is preferentially performed by transperitoneal approach. Despite offering advantages the direct retroperitoneal laparoscopic approach has not found uniform acceptance due to small working space in the retroperitoneum. Retroperitoneoscopy is our preferred approach for performing radical nephrectomy for localized renal tumors. We present our technique and our experience with the first 50 retroperitoneoscopic radical nephrectomies and compare the results with other series.
50 patients underwent retroperitoneoscopic radical nephrectomy for renal tumors cT1/cT2 between march 2004 to march 2007. A four ports retroperitoneal laparoscopic nephrectomy technique is performed with the patient in the full flank position. An artisanal balloon is used to create the retroperitoneal working space. The specimen is extracted intact by an extraperitoneal iliac incision. Follow up data were retrospectively reviewed.
Mean tumor size was 5.3 cm (3 to 13 cm), surgical time was 150 min (90 to 300 min), and blood loss was 130 ml (40-1000 ml). Average hospital stay was 2.2 days (1-11 days). Complications occurred in 6 (12%) patients. Two patients (4%) presented major complications and one of then require open conversion. Four patients (8%) presented minor complications. There were two later recurrences. One local and port site recurrence in a pT3aN0M0 renal cancer and one systemic metastases in a pT3N0M0 urothelial cancer occurred. Both cases presented inadequately extraction.
Retroperitoneoscopy is a feasible, effective and safe alternative for the treatment of localized renal tumors. Retroperitoneoscopy should be avoided in advanced and large size renal tumors.
腹腔镜根治性肾切除术优先采用经腹腔途径进行。尽管直接腹膜后腹腔镜途径具有优势，但由于腹膜后工作空间狭小，尚未得到广泛认可。腹膜后腹腔镜检查是我们对局限性肾肿瘤进行根治性肾切除术的首选方法。我们介绍我们的技术以及前50例腹膜后腹腔镜根治性肾切除术的经验，并将结果与其他系列进行比较。
2004年3月至2007年3月期间，50例患者因肾肿瘤cT1/cT2接受了腹膜后腹腔镜根治性肾切除术。采用四孔腹膜后腹腔镜肾切除术技术，患者取完全侧卧位。使用自制球囊创建腹膜后工作空间。通过腹膜外髂切口完整取出标本。对随访数据进行回顾性分析。
平均肿瘤大小为5.3 cm（3至13 cm），手术时间为150分钟（90至300分钟），失血量为130 ml（40 - 1000 ml）。平均住院时间为2.2天（1至11天）。6例（12%）患者出现并发症。2例（4%）出现严重并发症，其中1例需要转为开放手术。4例（8%）出现轻微并发症。有2例术后复发。1例pT3aN0M0肾癌出现局部和切口部位复发，1例pT3N0M0尿路上皮癌出现全身转移。两例均为取出不充分所致。
腹膜后腹腔镜检查是治疗局限性肾肿瘤的一种可行、有效且安全的替代方法。对于晚期和大尺寸肾肿瘤应避免采用腹膜后腹腔镜检查。
