Comparing surgical approaches in nephrectomy patients

By Sally Robertson, B.Sc.Nov 8 2012

The retroperitoneal approach to laparoscopic nephrectomy may provide a suitable alternative to the transperitoneal approach for patients, show findings from a literature review.

Patients who underwent retroperitoneal laparoscopic radical nephrectomy (RLRN) had a shorter time to renal vascular control and a lower overall complication rate than those who underwent transperitoneal LRN (TLRN). In addition, patients who underwent RL partial nephrectomy (RLPN) had a shorter operating time and a shorter length of stay in hospital than TLPN 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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