title: [Laparoscopic radical nephrectomy in big surgical specimens].
abstract: BACKGROUND
  The retroperitoneal surgery is the clearer indication for the laparoscopic approach. Still there are indications for open surgery because of the complexity of the patient and the surgeon experience.
  
  
  OBJECTIVE
  The main objective is to report our experience of laparoscopic radical nephrectomies in patient with tumors greater than 7 cm. or surgical specimens with more than 700 g of weight. We analyze their characteristics, complications rate, surgical time, postoperative outcome and hospital stay.
  
  
  METHODS
  Since July 2004 to July 2008 we have performed 104 laparoscopic radical nephrectomies. We have selected 41 patients with characteristics of big surgical specimens.
  
  
  RESULTS
  The average surgical time has been of 184,3 min. Only 1 case has been converted into open surgery and only 1 intraoperative death because of cardiologic arrhythmia. The average hospital stay has been of 3,51 days. The complications rate and postoperative outcome are similar to the whole series.
  
  
  CONCLUSIONS
  Laparoscopic nephrectomy is technically less complex than radical prostatectomy. However, their possible complication implies a much bigger severity. The more complex cases must be approach laparoscopically only after a wide experience. Actually, in our department we usually indicate an open approach when surgical specimen crossover the abdominal middle line and in those cases where the tumoral thrombus affect the main renal vein and/or the vena cava.
authors.affiliation: Servicio de Urología, Hospital Universitario La Paz, Madrid, España. garavelos@terra.es
authors.forename: Sergio
authors.initials: S
authors.lastname: Alonso y Gregorio
authors.forename: S
authors.initials: S
authors.lastname: Sánchez
authors.forename: C
authors.initials: C
authors.lastname: Soler
authors.forename: A
authors.initials: A
authors.lastname: Rando
authors.forename: M
authors.initials: M
authors.lastname: Girón
authors.forename: Angel J
authors.initials: AJ
authors.lastname: Tabernero Gómez
authors.forename: A
authors.initials: A
authors.lastname: Aguilera
authors.forename: Jesús
authors.initials: J
authors.lastname: Cisneros Ledo
authors.forename: Javier
authors.initials: J
authors.lastname: de la Peña Barthel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*