title: Transperitoneal laparoscopic radical nephrectomy is an effective procedure for large (more than 7 cm) renal masses.
abstract: OBJECTIVE
  We aimed to evaluate our experience with the transperitoneal radical nephrectomy (TLRN) in patients with large (more than 7 cm) renal mass to determine if this procedure can be recommended as a reference standard for treating large renal masses.
  
  
  METHODS
  Of 213 patients who underwent TLRN in both institutions we have reviewed medical files of 35 who had large than 7 cm renal masses. Operative time, blood loss, conversion rate, pathologic tumor type, and oncologic outcome were evaluated.
  
  
  RESULTS
  The mean tumor size was 10.1 cm (range: 7 to 19 cm). Mean blood loss during surgery was 388 mL (range: 150 to 600 mL). In 2 patients with 16 cm renal masses the operation was converted to hand-assisted technique as planned upon the surgery after ligation and transsection of the vascular pedicel to facilitate kidney dissection from surrounding tissue. In 1 patient the operation was converted to the open technique. Twenty-two (62.8%) patients had renal cell carcinoma and the remaining 13(37.5%) patients had other types of the renal tumors. Mean hospital stay was 4.36 days (range: 3 to 7 d). Median follow-up after the surgery was 29 months (range: 8 to 60 mo). Three patients who underwent cytoreduction nephrectomy died whereas receiving immunotherapy 3, 8, and 11 months, respectively, after surgery. One patient developed a local tumor recurrence and 2 developed remote metastasizes.
  
  
  CONCLUSIONS
  Our data show that TLRN is an effective procedure for the removal larger than 7 cm renal tumors. In those patients with exceptionally big tumors planned conversion to the hand-assisted technique after laparoscopic ligation of the renal vessels enabling easier renal dissection whereas preserving the advantages of minimally invasive procedure.
authors.affiliation: Department of Urology, Shaare Zedek Medical Center, Affiliated with Hebrew University Jerusalem, Jerusalem, Israel. bchertin@yahoo.com
authors.forename: Boris
authors.initials: B
authors.lastname: Chertin
authors.forename: Shalva
authors.initials: S
authors.lastname: Benjamin
authors.forename: Pethachia
authors.initials: P
authors.lastname: Reissman
authors.forename: Alexander
authors.initials: A
authors.lastname: Kheifets
authors.forename: Orly
authors.initials: O
authors.lastname: Prat
authors.forename: Ofer Z
authors.initials: OZ
authors.lastname: Shenfeld
authors.forename: Ami A
authors.initials: AA
authors.lastname: Sidi
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsivian
mesh_terms: D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D010537:Peritoneum / Q000601:surgery