What are the reported outcomes for extraperitoneal nephrectomy?

Updated: Sep 24, 2019
  • Author: Michael Grasso, III, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Randomized trials have compared RLN to transperitoneal laparoscopic nephrectomy (TLN). [35, 36, 37] The largest, by Desai et al, prospectively randomized 102 consecutive patients with renal masses to RLN or TLN. [38] Compared with TLN, RLN demonstrated significantly shorter time to hilar control, as well as shorter operative time, with no differences observed for estimated blood loss, hospital stay, intraoperative or postoperative complications, or postoperative analgesia requirements. This study excluded obese patients with a body mass index (BMI) of greater than 35.

In a follow-up, nonrandomized, prospective trial, RLN was compared with TLN in 51 consecutive, morbidly obese patients with a BMI greater than 40. [39] Although not achieving statistical significance, trends indicated decreased estimated blood loss and decreased open conversions with RLN compared with TLN. A prospective, randomized trial of RLN to open radical nephrectomy for 352 consecutive T1 renal tumors did demonstrate statistically significant reduction in blood loss, narcotic requirements, and hospital stay using the RLN approach. [40]

Retrospective series report similar oncological efficacy when comparing the RLN and TLN approaches. [41, 42] No cases of trocar-site metastasis have been reported with RLN. [43]

Additionally, a recently published study by the author’s group included a subset of patients (n=80) who underwent retroperitoneal laparoscopic nephroureterectomy for upper tract urothelial carcinoma. Results showed similar oncologic and long-term outcomes compared with other reported nephroureterectomy series using the traditional transabdominal approach. [44, 45]

Historically, there have been many studies reporting the physiologic advantages of retroperitoneal laparoscopy. A very recent prospective study out of Egypt studied these advantages. [16] This group randomized 30 adult patients into 15 undergoing retroperitoneal laparoscopic nephroureterectomy and 15 transperitoneal laparoscopic nephroureterectomy for simple laparoscopic nephrectomy. Results showed that mean arterial pressure, heart rate, blood carbon dioxide level, peak airway pressure, and initial cerebral blood flow velocity were significantly greater with transperitoneal laparoscopic nephroureterectomy than retroperitoneal laparoscopic nephroureterectomy during the carbon dioxide insufflation period. This led the authors to conclude that retroperitoneal laparoscopic nephroureterectomy is not associated with greater effects on ventilatory, hemodynamic, and cerebral functions compared with transperitoneal laparoscopy.

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