Retroperitoneal laparoscopic radical nephrectomy: The Cleveland Clinic experience

Purpose: Laparoscopic radical nephrectomy is usually performed by the trans peritoneal approach. At our institution the retroperitoneoscopic approach i s preferred. We confirm the technical feasibility of retroperitoneoscopic r adical nephrectomy, even for large specimens, and compare its results with open surgery in a contemporary cohort. Materials and Methods: A total of 47 patients underwent 53 retroperitoneosc opic radical nephrectomies. Data from the most recent 34 laparoscopic cases were retrospectively compared with 34 contemporary cases treated with open radical nephrectomy. Results: For the 53 retroperitoneoscopic radical nephrectomies mean tumor s ize was 4.6 cm. (range 2 to 12), surgical time was 2.9 hours (range 1.2 to 4.5) and blood loss was 128 cc. Mean specimen weight was 484 gm. (range 52 to 1,328), and concomitant adrenalectomy was performed in 72% of patients. Mean analgesic requirement was 31 mg. morphine sulfate equivalent. Average hospital stay was 1.6 days, with 68% of patients discharged from the hospit al within 23 hours of the procedure. Minor complications occurred in 8 pati ents (17%) and major complications occurred in 2 (4%) who required conversi on to open surgery. Various parameters, including patient age, body mass in dex, American Society of Anesthesiologists status, tumor size (5 versus 6.1 cm.), specimen weight (605 versus 638 gm.) and surgical time (3.1 versus 3 .1 hours), were comparable between patients undergoing laparoscopic (34) an d open (34) radical nephrectomy. However, laparoscopy resulted in decreased blood loss (p <0.001), hospital stay (p <0.001), analgesic requirements (p <0.001) and convalescence (p = 0.005). Complications occurred in 13% of pa tients in the laparoscopic group and 24% in the open group. Conclusions: Retroperitoneoscopy is a reliable, effective and, in our hands , the preferred technique of laparoscopic radical nephrectomy. At our insti tution retroperitoneoscopy has emerged as an attractive alternative to open radical nephrectomy in patients with T1-T2N0M0 renal tumors.