title: Retroperitoneal laparoscopic radical nephrectomy: the Cleveland clinic experience.
abstract: OBJECTIVE
  Laparoscopic radical nephrectomy is usually performed by the transperitoneal approach. At our institution the retroperitoneoscopic approach is preferred. We confirm the technical feasibility of retroperitoneoscopic radical nephrectomy, even for large specimens, and compare its results with open surgery in a contemporary cohort.
  
  
  METHODS
  A total of 47 patients underwent 53 retroperitoneoscopic radical nephrectomies. Data from the most recent 34 laparoscopic cases were retrospectively compared with 34 contemporary cases treated with open radical nephrectomy.
  
  
  RESULTS
  For the 53 retroperitoneoscopic radical nephrectomies mean tumor size was 4.6 cm. (range 2 to 12), surgical time was 2.9 hours (range 1.2 to 4.5) and blood loss was 128 cc. Mean specimen weight was 484 gm. (range 52 to 1,328), and concomitant adrenalectomy was performed in 72% of patients. Mean analgesic requirement was 31 mg. morphine sulfate equivalent. Average hospital stay was 1.6 days, with 68% of patients discharged from the hospital within 23 hours of the procedure. Minor complications occurred in 8 patients (17%) and major complications occurred in 2 (4%) who required conversion to open surgery. Various parameters, including patient age, body mass index, American Society of Anesthesiologists status, tumor size (5 versus 6.1 cm.), specimen weight (605 versus 638 gm.) and surgical time (3.1 versus 3.1 hours), were comparable between patients undergoing laparoscopic (34) and open (34) radical nephrectomy. However, laparoscopy resulted in decreased blood loss (p <0.001), hospital stay (p <0.001), analgesic requirements (p <0.001) and convalescence (p = 0.005). Complications occurred in 13% of patients in the laparoscopic group and 24% in the open group.
  
  
  CONCLUSIONS
  Retroperitoneoscopy is a reliable, effective and, in our hands, the preferred technique of laparoscopic radical nephrectomy. At our institution retroperitoneoscopy has emerged as an attractive alternative to open radical nephrectomy in patients with T1-T2N0M0 renal tumors.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: I S
authors.initials: IS
authors.lastname: Gill
authors.forename: D
authors.initials: D
authors.lastname: Schweizer
authors.forename: M G
authors.initials: MG
authors.lastname: Hobart
authors.forename: G T
authors.initials: GT
authors.lastname: Sung
authors.forename: E A
authors.initials: EA
authors.lastname: Klein
authors.forename: A C
authors.initials: AC
authors.lastname: Novick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009820:Ohio; D011183:Postoperative Complications; D012189:Retrospective Studies