title: 100-minute retroperitoneoscopic radical nephrectomy: a new retroperitoneal approach with a hand assisted method.
abstract: OBJECTIVE
  A new approach for retroperitoneoscopic radical nephrectomy is introduced. The point of our surgical method is the application of a combination of hand assistance and pure laparoscopic procedures with appropriate surgical steps via the retroperitoneal approach. In our early series we had good surgical results and we completed radical nephrectomy in about 100 minutes using this procedure.
  
  
  METHODS
  A total of 20 consecutive patients with renal cell carcinoma (cT1-2) who were operated on with this surgical method were analyzed. Surgical procedures occurred in 5 steps. In step 1 the retroperitoneal space was created manually from a pararectal incision at the umbilicus level. In step 2 the lateroconal fascia was incised and the renal hilar area was exposed with hand assistance. In step 3 hilar dissection was performed by pure laparoscopic procedure with another surgical instrument inserted from the hand device. Step 4 involved the application of hand assistance again for the quick mobilization of the kidney and adrenal gland. In step 5 the intact surgical specimen was retrieved from the hand device.
  
  
  RESULTS
  Mean operative time and estimated blood loss were 103 +/- 21 minutes (range 70 to 145) and 49 +/- 85 ml (range 5 to 360), respectively. Mean days to oral intake and ambulation were 1.0 and 1.1, respectively. Operative times of the steps of hilar dissection and mobilization of the kidney and adrenal were shorter than in other series performed by standard retroperitoneoscopic radical nephrectomy. Major complications were not experienced. At this point, no metastasis has been experienced.
  
  
  CONCLUSIONS
  Our surgical method may have the benefits of the retroperitoneal approach and hand assistance. The retroperitoneoscopic hand assisted method may be another important option in the 3 major approaches for laparoscopic radical nephrectomy, although longer-term followup is clearly required.
authors.affiliation: Sanjukai Urological Hospital, Sanriki Basic and Clinical Research Center, Sapporo, Japan. ysato@sanjukai.or.jp
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Sato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tanda
authors.forename: Shuji
authors.initials: S
authors.lastname: Kato
authors.forename: Shigeki
authors.initials: S
authors.lastname: Onishi
authors.forename: Hisao
authors.initials: H
authors.lastname: Nakajima
authors.forename: Akihito
authors.initials: A
authors.lastname: Nanbu
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Nitta
authors.forename: Mikio
authors.initials: M
authors.lastname: Koroku
authors.forename: Keigo
authors.initials: K
authors.lastname: Akagashi
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Hanzawa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D013997:Time Factors