title: Direct access to the renal artery at the level of treitz ligament during left radical laparoscopic transperitoneal nephrectomy.
abstract: OBJECTIVE
  To describe and demonstrate the feasibility of early ligature of the renal artery using a direct access to the renal pedicle at the level of the Treitz ligament during left transperitoneal radical laparoscopic nephrectomy.
  
  
  METHODS
  A total of 42 patient underwent left transperitoneal radical laparoscopic nephrectomies from February 2001 to July 2004. In the first consecutive 27 patients (Group A) we performed early ligature with the standard technique; in the last consecutive 15 patients (Group B) we attempted the early ligature with direct access to the renal artery at the level of the Treitz ligament. Comparative analysis was carried out between the two groups examining operative times, blood loss, intra and post operative complications, postoperative stay.
  
  
  RESULTS
  No difference was noted in gender, age and size of the lesions (6.2 versus 6.25 cm respectively, p = 0.9) in the two groups. In 12/15 (80%) of Group B cases we successfully identified and ligated the renal artery at the level of the Treitz ligament. In the other 3 cases (20%) we were constrained to revert to the more common laparoscopic approach. Mean Operative times were 131' in group A versus 137' in group B (p = 0.15). The time required to find the renal artery at the level of Treitz ligament in group B was 16' (15'-30'). No differences were noted between the two groups in terms of blood loss (222 cc versus 268 ml, p = 0.4), intraoperative and postoperative complications (p = 0.6), postoperative stay (5 days in the two groups, p = 0.9). Mean follow-up was average 24 months (15-48) in Group A and average 7 months (3-12) in Group B. No complications and no recurrence of disease at CT evaluation were recorded neither in Group A nor in Group B.
  
  
  CONCLUSIONS
  Radical laparoscopic left side nephrectomy with direct access to the renal artery at the level the Treitz ligament is technically feasible and safe and reproduces the classic principles of radical nephrectomy allowing to perform the procedure without any manipulation of the tumor.
authors.affiliation: Division of Urology, Department of Clinical and Biological Sciences-University of Turin, "San Luigi" Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy. porpiglia@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.forename: Cecilia
authors.initials: C
authors.lastname: Cracco
authors.forename: Julien
authors.initials: J
authors.lastname: Renard
authors.forename: Francesca
authors.initials: F
authors.lastname: Musso
authors.forename: Susanna
authors.initials: S
authors.lastname: Grande
authors.forename: Roberto Mario
authors.initials: RM
authors.lastname: Scarpa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy; D008022:Ligaments; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome