title: [Safe retroperitoneoscopic radical nephrectomy with small incision for renal cell carcinoma].
abstract: OBJECTIVE
  Retroperitoneoscopic radical nephrectomy (RRN) has been performed at Yokohama City University Medical Center since May 2002. Three surgeons have become skilled in performing RRN without major complications. We investigated the outcomes of the surgery and attempt to clarify whether the technique we adopted is suitable to perform this procedure safely.
  
  
  METHODS
  Between May 2002 and June 2003, 14 patients suspected of renal cell carcinoma underwent retroperitoneoscopic radical nephrectomy at Yokohama City University Medical Center. The surgical procedure is shown below. In a lateral position, a lumbar oblique incision 6 cm long is made to approach the retroperitoneal space. Under direct vision, the ureter is dissected and Gerota's fascia is dissected from the peritoneum and the psoas muscle to signalize the subsequent dissection line. After the dissection, hand port device was attached to the skin and three 12 mm trocars were placed. The subsequent procedures are performed by retroperitoneoscopic surgery with carbon dioxide insufflation. The isolated kidney was removed through the incision that was made initially. We investigated the outcomes of this procedure.
  
  
  RESULTS
  The mean surgical duration was 244.4 minutes and mean blood loss was 217.9 ml. Conversion to open surgery was required in one case due to bleeding and in one case due to incomplete management of a small artery. Blood transfusion was not required in any case. There were no major complications during the perioperative period.
  
  
  CONCLUSIONS
  The three operators have become skilled in performing RRN safely with this technique.
authors.affiliation: Department of Urology, Yokohama City University Medical Center.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Makiyama
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Fujinami
authors.forename: Kotaro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Shinpei
authors.initials: S
authors.lastname: Sugiura
authors.forename: Junichi
authors.initials: J
authors.lastname: Teranishi
authors.forename: Futoshi
authors.initials: F
authors.lastname: Sano
authors.forename: Kazuo
authors.initials: K
authors.lastname: Saito
authors.forename: Kazumi
authors.initials: K
authors.lastname: Noguchi
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kubota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods