Chao Zhang1, Fubo Wang1, Xiaolei Shi1, Fei Guo1, Huiqing Wang1, Yue Yang1, Xiaofeng Gao2, Bo Yang3. 1. Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China. 2. Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: gxfdoc@sina.com. 3. Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: yangbochanghai@126.com.
Abstract
OBJECTIVE: To describe a novel technique of laparoscopic partial nephrectomy (LPN) with direct lateral access (DLA) to renal artery and to report our early outcomes with this technique. MATERIALS AND METHODS: A retrospective review of 135 cases of transperitoneal LPN done by a single surgeon at our tertiary care institution from August 2014 to December 2016 was performed. Standard LPN (n = 73) or DLA-LPN (n = 62) was performed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and surgical outcomes (operative time, artery mobilization time, warm ischemia time, estimated blood loss, complications, and so on). A comparative analysis between standard LPN cases and DLA-LPN was performed. RESULTS: The use of DLA technique had shorter operative time (P <.001), which was mainly due to a shorter artery mobilization time (18.1 vs 25.6 minutes; P <.001). This time difference was more significant in case of "complex" renal vasculature (2 or more arteries, P <.001). There was no difference in terms of perioperative complications between the 2 techniques. CONCLUSION: DLA to renal artery is safe and feasible, and it may translate into a shorter operative time. This can represent a useful trick to facilitate a challenging step of the LPN procedure, especially in case of complex vascular anatomy.
OBJECTIVE: To describe a novel technique of laparoscopic partial nephrectomy (LPN) with direct lateral access (DLA) to renal artery and to report our early outcomes with this technique. MATERIALS AND METHODS: A retrospective review of 135 cases of transperitoneal LPN done by a single surgeon at our tertiary care institution from August 2014 to December 2016 was performed. Standard LPN (n = 73) or DLA-LPN (n = 62) was performed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and surgical outcomes (operative time, artery mobilization time, warm ischemia time, estimated blood loss, complications, and so on). A comparative analysis between standard LPN cases and DLA-LPN was performed. RESULTS: The use of DLA technique had shorter operative time (P <.001), which was mainly due to a shorter artery mobilization time (18.1 vs 25.6 minutes; P <.001). This time difference was more significant in case of "complex" renal vasculature (2 or more arteries, P <.001). There was no difference in terms of perioperative complications between the 2 techniques. CONCLUSION: DLA to renal artery is safe and feasible, and it may translate into a shorter operative time. This can represent a useful trick to facilitate a challenging step of the LPN procedure, especially in case of complex vascular anatomy.