[Retrospective study of laparoscopic peritoneal radical nephrectomy].
OBJECTIVE
To analyse the results of laparoscopic radical nephrectomy in terms of feasibility, safety, morbidity and tumour control.


METHODS
Between August 1993 and July 1998, 29 laparoscopic retroperitoneal radical nephrectomies were performed in 17 men and 12 women for renal tumours less than or equal to 90 mm in diameter. The working space was created by finger dissection without using a dilatation balloon. Four additional trocars were inserted under digital control. The renal pedicle was dissected first: the renal artery was clipped and the renal vein was sectioned by EndoGIA. After sectioning the ureter, the kidney was dissected with the perirenal fat and Gerota's fascia. The operative specimen was extracted in an impermeable endoscopy bag, without division, by enlarging the first trocar incision to 50 mm in order to avoid any parietal contact.


RESULTS
The mean age of the patients was 61.3 years (range: 40 to 78 years). Radical nephrectomy was performed on 13 right kidneys and 16 left kidneys, with mean dimensions of 112.9 mm (range: 85 to 150 mm). The mean tumour diameter was 40.2 mm (range: 20 to 90 mm). The mean operating time was 145 min (range: 80 to 330 min) with a mean blood loss of 100 cc (range: 0 to 1000 cc). A mean daily dose of 2.8 g (range: 1 to 5 g) of parenteral paracetamol and a mean daily dose of 1.8 mg (range: 0 to 10 mg) of morphine hydrochloride were necessary postoperatively. The mean hospital stay was 4.8 days (range: 1 to 11 days). One intraoperative haemorrhage required open conversion and one colon injury was treated by temporary colostomy. One local recurrence with hepatic metastasis occurred 9 months after the operation in a patient operated for a Furhman grade II stage pT3 tumour with negative resection margins.


CONCLUSIONS
Laparoscopic radical nephrectomy is currently under evaluation. This technique is feasible, and respects the principles of cancer surgery: primary control of renal vessels, en bloc extraction of the kidney with Gerota's fascia.
Cicco
A
A
Service d'Urologie, CHU Henri Mondor, Créteil, France.
Salomon
L
L
Gasman
D
D
Hoznek
A
A
Chopin
D
D
Abbou
C C
CC
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000473:pathology / Q000601:surgery; D016063:Blood Loss, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors
Etude rétrospective des néphrectomies élargies par voie laparoscopique rétropéritonéale.