Comparison of Techniques for Laparoscopic Radical Nephrectomy in a Single Center: Transperitoneal vs. Retroperitoneal vs. Hand-Assisted

ABSTRACT

PURPOSE: Laparoscopic surgery has become the standard method of radical nephrectomy within the urological community. We compared the safety and efficacy of different techniques for laparoscopic radical nephrectomy (LRN) in a single medical center. MATERIALS AND METHODS: Between June 2002 and August 2007, we performed LRN for renal cell cancer in 45 cases by a transperitoneal approach (TLRN), in 21 cases by a retroperitoneal approach (RLRN), and in 32 cases by a hand-assisted approach (HLRN), and the results of each approach were compared. Surgical results such as operative time, estimated blood loss (EBL), transfusion rate, hospital stay, complications, and pathologic results were reviewed retrospectively and analyzed by one-way ANOVA. RESULTS: There were no significant differences in demographic data among the 3 groups. The pathologic reports showed clear cell type in 97 cases and chromophobe type in 1 case. For each group (TLRN vs. RLRN vs. HLRN), the mean operative time was 207.9+/-57.06 vs. 211.8+/-52.85 vs. 184.4+/-49.43 minutes, respectively (p=0.03); the EBL was 135.0+/-29.40 vs. 153.8+/-45.59 vs. 183.4+/-89.25 ml, respectively (p=0.14); time to oral intake was 2.3+/-0.79 vs. 1.2+/-0.54 vs. 2.6+/-0.84 days, respectively (p<0.01); and the hospital stay was 6.7+/-0.77 vs. 5.4+/-0.73 vs. 8.2+/-1.51 days, respectively (p<0.01). There were no severe complications. The pathologic surgical margins were all negative. CONCLUSIONS: LRN can be performed efficiently and effectively with the transperitoneal, retroperitoneal, and hand-assisted techniques. Operators may select the technique for LRN according to their own preferences. In our experience, RLRN may protect the organ from injury and promote the recovery of lifestyle because of the early recovery of bowel movement.