title: Comparison of two approaches to retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria.
abstract: OBJECTIVE
  The retroperitoneoscopic renal pedicle lymphatic disconnection has been performed mainly via a renal adipose (RA) capsule approach. In this study, we reported a novel technique via extra-adipose (EA) capsule approach and compared the two approaches for intractable chyluria.
  
  
  METHODS
  From December 2002 to March 2008, retroperitoneoscopic renal pedicle lymphatic disconnection was performed on 41 patients with 23 EA and 18 RA. The stripping of hilar vessels and ureterolympholysis were performed in both approaches, while the mobilization of the kidney was only performed in RA. Comparisons of the two approaches were conducted, including mean operative time, intraoperative blood loss, postoperative bed rest, and hospital stay, as well as operative outcome.
  
  
  RESULTS
  Patients were treated successfully without major complications. EA showed the same advantages as RA in terms of intraoperative blood loss (54.9±19.3 mL vs 59.3±26.5 mL, P>0.05), postoperative hospital stay (6.6±1.0 d vs 7.2±0.9 d, P>0.05). Chyluria disappeared in all patients immediately after the operations. EA was significantly superior to RA in operative time (78.9±18.3 min vs 101.8±20.6 min, P<0.05) and the postoperative bed rest time (20.7±1.7 h vs 72.0±0.0 h, P<0.05). No recurrence or nephroptosis was diagnosed in any patient within the follow-up of 21 to 84 months.
  
  
  CONCLUSIONS
  Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is safe and efficacious. EA offers significantly shorter operative time and earlier return to postoperative ambulation.
authors.affiliation: Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China.
authors.forename: Cheng-Jing
authors.initials: CJ
authors.lastname: Zhang
authors.forename: Ren-Fu
authors.initials: RF
authors.lastname: Chen
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Sun
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Zhu
authors.forename: Ru-Min
authors.initials: RM
authors.lastname: Wen
authors.forename: Jun-Qi
authors.initials: JQ
authors.lastname: Wang
authors.forename: Jia-Cun
authors.initials: JC
authors.lastname: Chen
authors.forename: Jun-Nian
authors.initials: JN
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D002913:Chyle / Q000378:metabolism*; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D042601:Lymphatic Vessels / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space / Q000601:surgery*; D016896:Treatment Outcome; D014556:Urine; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult