Comparing surgical approaches in nephrectomy patients

In their analysis of 18 studies comparing the two approaches, Zi Yin (Sun Yat-sen University, Guangzhou, China) and colleagues found that time to renal artery control was a significant 69 minutes longer with TLRN than in RLRN, while time to renal vein control was 54 minutes longer.

"The transperitoneal approach requires considerable mobilization to access the renal helium, whereas the retroperitoneal approach provides direct and rapid access to the renal helium," they explain in BJU International.

Operating time with RLPN was also 49 minutes shorter than with TLPN, and RLPN patients spent 1 day less in hospital than TLPN patients.

Furthermore, the overall complication rate was significantly lower in RLRN than TLRN patients, as was the intraoperative complication rate, at respective odds ratios of 2.12 and 2.17.

"These findings cannot support a claim that RLRN is safer than TLRN, as allocation to treatment groups was at the discretion of the attending physician in most studies, with TLRN used more often in complicated cases," the team points out. "But our analysis does indicate that RLRN is at least as safe as TLRN."

"In appropriately selected patients, especially patients with posteriorly located renal tumours, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach," conclude the researchers.

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