Laparoscopic Radical Nephrectomy
– The Cohort of 150 Patients
1Eret V., 1Hora M., 1Klečka J., 1Stránský P., 2Ferda J., 3Hes O., 1Ürge T.
1Urologická klinika LF UK a FN, Plzeň 2Radiodiagnostická klinika LF UK a FN, Plzeň 3Šiklův patologicko-anatomický ústav LF UK a FN, Plzeň
Background. Minimally invasive surgery has been performing in the treatment of renal cancer at the
Department of Urology in Plzeň since January 2003. We want to present and evaluate our results of
laparoscopic nephrectomy (LRN) in the cohort of 150 patients.
Methods and Results. In our institution, 150 LRNs were performed in the period between January 2003
and April 2007, 145 of them transperitoneally and 5 retroperitoneally. These 150 LRNs were completed
by 4 different surgeons. We use four trocars in a rhombus disposition for left-sided LRN, we add fifth
port for liver elevation for right-sided LRN. We place four ports for retroperitoneoscopical LRN. Renal
vessels are sectioned either separately with lockable clips or with endoGIA stapler en bloc. After
mobilization of the kidney, it is inserted into the endobag and extracted through the extended incision
after the 12 mm port in lower abdomen using splitting incision. 73 right and 77 left LRN were performed
in our patients cohort. The mean age of patients was 62.5±10.2 (range 33.9–84.6) years. The mean
operation time was 138±44 (55–270) minutes. The mean size on CT was 54.3±15.1 (29–101) mm. The
mean hospitalization time was 6.1±2 (3–15) days. Adrenalectomy was performed in 16 patients,
cholecystectomy in 4 patients and appendectomy in 3 patients. Per- operative complications appeared in
5 cases (3 %). Post- operative complications appeared in 7 patients (5 %). We can not evaluate own
oncological results because of short-time follow-up.
Conclusions: LRN has become a new gold standard in the treatment of kidney tumours T1 (to 7 cm) and
it represents an important approach in the treatment of kidney tumours in our institution. We highly
recommend preoperatively biphasic CT angiography because it shows the exact number and topography
of renal vessels. We prefer transperitoneal approach because of the larger working space and better
topographical orientation. Patients profit from advantages of miniinvasivity mainly due to the faster return to the normal life. To the main disadvantages of this technique belong the higher technical
demands on the operator and a higher prize of the procedure compared to the open operation.
renal cancer, minimally invasive surgical procedure, laparoscopy, nephrectomy