Initial Experience of Retroperitoneal Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

ABSTRACT

PURPOSE: A retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is useful as an approach to urological surgery. Here, our initial experience of retroperitoneal laparoscopic radical nephrectomies, in 18 consecutive patients with renal cell carcinomas, is reported. MATERIALS AND METHODS: The records of 18 consecutive patients, with renal cell carcinomas, that underwent a retroperitoneal laparoscopic radical nephrectomy between June 2000 and September 2002, were reviewed. RESULTS: The retroperitoneal laparoscopic radical nephrectomies, for the renal cell carcinomas, were successfully performed in all but 3 patients. These 3 were converted to an open technique due to severe adhesion in 1 and bleeding in the other 2. Of the 15 renal cell carcinomas, the final pathological stages were pT1N0M0 in 14 and pT2N0M0 in 1. The mean tumor size and specimen weight were 4.3cm, ranging from 2 to 7.5cm and 258gm, ranging from 203 to 372gm, respectively. The tumors involved the upper pole, the mid pole and the lower pole in 5, 6 and 4 cases, respectively. The mean operative time and estimated blood loss were 195 minutes, ranging from 160 to 260 minutes, and 181.3cc, ranging from 50 to 500cc, respectively. In 4 of the 15 patients, Patient-Controlled Analgesia (PCA) were used for the control of post operative pain, the other 11 required minimal postoperative analgesics. The mean interval to resuming oral intake and hospital stay were 2.3 days, ranging from 2 to 3 days, 5.4 days, ranging from 4 to 7 days, respectively. Complications occurred in 2 patients, and included partial atelectasis in 1 and pulmonary edema in the other. Neither local recurrence nor distant dissemination was observed during the mean follow-up of 13.6 months (range 4 to 25). CONCLUSIONS: A retroperitoneal laparoscopic radical nephrectomy is a safe and effective alternative, to an open radical nephrectomy, in patients with a localized renal cell carcinoma.