title: A modified adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy.
abstract: BACKGROUND
  The objective of this study was to modify the adrenal gland-sparing strategy based on retroperitoneal laparoscopic radical nephrectomy by reviewing the anatomic relationship between the kidney and the adrenal gland.
  
  
  METHODS
  From June 2010 to October 2012, a total of 68 patients (45 males and 23 females) with localized renal cell carcinoma were treated at our hospital. The study included 35 cases that were right side and 33 cases that were left, and average patient age was 54.06 years. The average tumor size was 4.7 cm. Tumors were classified via the TNM staging system. All patients underwent adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy.
  
  
  RESULTS
  For each patient, surgery was successful without conversion to open surgery. The average operative time was 56.65 ± 26.60 min, and the mean blood loss was 70.61 ± 60.96 ml. All patients were discharged from the hospital 3 to 8 days after surgery. During surgery, the adrenal gland was slightly lacerated in three cases and the peritoneum showed perforation in six cases. Only one case recurred during the study follow-up.
  
  
  CONCLUSIONS
  Based on retroperitoneal laparoscopy radical nephrectomy, this effective adrenal gland-sparing surgery showed direct exposure of tissue and little interference of the upper pole of the kidney. Elevation of the adrenal gland could help with the complete dissection of the adrenal gland from the kidney. The separation of the kidney was rapid, simple and accurate. The probability of adrenal gland damage was reduced. This strategy is recommended for widespread use in T1-2 renal neoplasms.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Xu
authors.forename: Zhengyu
authors.initials: Z
authors.lastname: Zhang
authors.forename: Jianping
authors.initials: J
authors.lastname: Gao
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Wei
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Xu
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
authors.forename: Hao
authors.initials: H
authors.lastname: Tang
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Yi
authors.forename: Chaopeng
authors.initials: C
authors.lastname: Tang
authors.affiliation: Department of Urology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing 210002, China. shzwqzsl@163.com.
authors.forename: Wenquan
authors.initials: W
authors.lastname: Zhou
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery; D000311:Adrenal Glands / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D059351:Organ Sparing Treatments; D011379:Prognosis; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery*