Direct Lateral Access to Renal Artery During Transperitoneal Laparoscopic Partial Nephrectomy: Surgical Technique and Comparative Outcomes.

OBJECTIVE

To describe a novel technique of laparoscopic partial nephrectomy (LPN) with direct lateral access (DLA) to renal artery and to report our early outcomes with this technique.

MATERIALS AND METHODS

A retrospective review of 135 cases of transperitoneal LPN done by a single surgeon at our tertiary care institution from August 2014 to December 2016 was performed. Standard LPN (n = 73) or DLA-LPN (n = 62) was performed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and surgical outcomes (operative time, artery mobilization time, warm ischemia time, estimated blood loss, complications, and so on). A comparative analysis between standard LPN cases and DLA-LPN was performed.

RESULTS

The use of DLA technique had shorter operative time (P <.001), which was mainly due to a shorter artery mobilization time (18.1 vs 25.6 minutes; P <.001). This time difference was more significant in case of "complex" renal vasculature (2 or more arteries, P <.001). There was no difference in terms of perioperative complications between the 2 techniques.

CONCLUSION

DLA to renal artery is safe and feasible, and it may translate into a shorter operative time. This can represent a useful trick to facilitate a challenging step of the LPN procedure, especially in case of complex vascular anatomy.