Laparoscopic radical nephrectomy

Citation
Md. Dunn et al., Laparoscopic radical nephrectomy, J ENDOUROL, 14(10), 2000, pp. 849-855
Citations number
26
Categorie Soggetti
Urology & Nephrology
Journal title
JOURNAL OF ENDOUROLOGY
ISSN journal
08927790 → ACNP
Volume
14
Issue
10
Year of publication
2000
Pages
849 - 855
Database
ISI
SICI code
0892-7790(200012)14:10<849:LRN>2.0.ZU;2-W
Abstract
Although open nephrectomy is the standard of care for localized renal-cell carcinoma, the significant postoperative pain and lengthy convalescence hav e encouraged the use of laparoscopy, which can yield similar 2- to 5-year s urvival rates, Either a transperitoneal or a retroperitoneal approach may b e used, and sometimes, they are combined. Generally, the technique is limit ed to tumors <10 cm, but larger tumors can be removed, Nitrous oxide is avo ided as an anesthetic agent. The dissection follows accepted oncologic prin ciples: in situ renal dissection within Gerota's fascia, early ligation of the renal vessels, and careful removal of the specimen to prevent tumor spi llage. Dissection of the hilum is facilitated by a PEER retractor and an En doholder. On average, patients having laparoscopic radical nephrectomy retu rn to normal activities approximately 4.5 weeks sooner than those having op en surgery, a fact not taken into account in cost analyses, Laparoscopic ne phrectomy may offer a special benefit in patients with known metastatic dis ease, as interleukin-2 administration can be started a month earlier than a fter open surgery, There may also be immunologic benefits of minimally inva sive <nu> open surgery. The technique and instruments continue to evolve, a nd cost-effectiveness should continue to improve.