title: [Technique of renal pedicle control in transperitoneal laparoscopic nephrectomy: experience of 191 cases by a single surgeon].
abstract: OBJECTIVE
  To explore the technique of vascular control in transperitoneal laparoscopic nephrectomy.
  
  
  METHODS
  From May 2010 to September 2013, 191 consecutive transperitoneal laparoscopic nephrectomies were performed by a single surgeon. The operations included 116 radical nephrectomies, 57 nephroureterectomies, and 18 simple nephrectomies. Improved 4-trocar method was applied. Through lifting up inferior pole of the kidney by an assistant, and observing renal vascular from the bottom or back of the kidney, the exposure of renal vessels were improved. The renal vessels were managed with Hem-o-lock or Endo GIA. For tumors of stage ≥ T2, ipsilateral lymph node dissection of renal hilus was performed.
  
  
  RESULTS
  Of the entire 191 cases,190 were performed successfully, only 1 converted to open surgery because of the difficulty in separating the tumor from the invaded colon. The average time of operation was 171.5 min (74-352). The blood loss was 5-1 000 mL with an average of 94.8 mL. The complications included vascular injuries (5 cases), cerebral infarction accompanied by acute renal injury (1 case), and pulmonary infection (2 cases). The mean postoperative hospital stay was 5.6 days (2-19 days). No perioperative death occurred.
  
  
  CONCLUSIONS
  The reformative technique of vascular control could improve the exposure of renal vessels, increase surgery safety, and shorten the time of transperitoneal laparoscopic nephrectomy.
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yao
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Xue-song
authors.initials: XS
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Tian-yu
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Fang
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Cui-jian
authors.initials: CJ
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Cai
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Shen
authors.affiliation: Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
authors.forename: Li-qun
authors.initials: LQ
authors.lastname: Zhou
mesh_terms: D058186:Acute Kidney Injury; D002544:Cerebral Infarction; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000601:surgery*; D007680:Kidney Neoplasms; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D020521:Stroke; D013525:Surgical Instruments; D014513:Ureter / Q000601:surgery