title: Laparoscopic renal surgery after spontaneous retroperitoneal hemorrhage.
abstract: OBJECTIVE
  We assessed the role of laparoscopic management in patients following spontaneous retroperitoneal hemorrhage from a renal tumor.
  
  
  METHODS
  A retrospective chart review revealed 4 patients with spontaneous retroperitoneal hemorrhage treated at our institution in the last 2 years. After conservative management elsewhere patients were referred for definitive therapy. Patient characteristics and tumor size were examined and correlated with ease of surgical dissection and surgical outcome. No patient had any history of trauma. Computerized tomography was used to identify the initial extent of hemorrhage in all patients.
  
  
  RESULTS
  All patients underwent successful laparoscopic exploration without the need for open conversion. Three patients underwent radical nephrectomy and 1 underwent laparoscopic partial nephrectomy. Renal hemorrhage extending outside of the renal capsule was associated with significantly more adhesions than renal hemorrhage confined to the renal capsule. Mean patient age was 56 years (range 36 to 70). Mean retroperitoneal tumor size was 5.3 cm (range 2.5 to 10). Three renal hematomas were extracapsular and 1 was subcapsular. Mean operative time was 182.3 minutes (range 59 to 235). Average estimated blood loss was 800 cc (range 150 to 2,100).
  
  
  CONCLUSIONS
  Nontraumatic retroperitoneal hemorrhage of renal origin may be managed using traditional laparoscopic techniques with results similar to those achieved with open renal exploration. These cases may prove technically challenging due to fibrosis and associated tissue plane loss.
authors.affiliation: James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Hernandez
authors.forename: Albert M
authors.initials: AM
authors.lastname: Ong
authors.forename: Koon H
authors.initials: KH
authors.lastname: Rha
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000328:Adult; D000368:Aged; D018207:Angiomyolipoma / Q000150:complications*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology*; D007680:Kidney Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012187:Retroperitoneal Space; D012189:Retrospective Studies