Laparoscopic Partial Nephrectomy: A Matched-pair Comparison of the Transperitoneal Versus the Retroperitoneal Approach
| Autor: | Martin Marszalek, Karl Pummer, Stephan Madersbacher, Thomas F. Chromecki, Richard Zigeuner, Klaus Jeschke, Badereddin Mohamad Al-Ali, Herbert Meixl |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Nephrology medicine.medical_specialty Matched-Pair Analysis Urology medicine.medical_treatment Renal function Nephrectomy Matched pair Internal medicine medicine Humans Laparoscopy Retroperitoneal approach Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Middle Aged medicine.disease Kidney Neoplasms Surgery Treatment Outcome Pneumothorax Female Peritoneum Positive Surgical Margin business |
| Zdroj: | Urology. 77:109-113 |
| ISSN: | 0090-4295 |
| Popis: | OBJECTIVES To compare surgical and functional results of both surgical approaches to endoscopic partial nephrectomy. It is currently performed either by the transperitoneal (t) or the retroperitoneal (r) approach. METHODS This was a retrospective, matched-pair comparison of 105 patients who underwent either transperitoneal laparoscopic (Graz) or retroperitoneoscopic (Klagenfurt) partial nephrectomy for clinical T1a renal masses. RESULTS A total of 35 patients after transperitoneal laparoscopic and 70 patients after retroperitoneoscopic partial nephrectomy were included to this analysis after matching for age (T: 59.3 vs R: 60.1 a), preoperative glomerular filtration rate (GFR) (T: 93.2 vs R: 96.1 mL/min) and tumor size (T: 2.4 vs R: 2.5 cm). Nephrometry scores were comparable between groups and were low, medium, and high in 54.3%, 45.7%, and 0% (t) and 55.7%, 42.9%, and 1.4% (r) of patients (P = .9). Operative time (T: 139.3 minutes vs. R: 83.9 minutes; P < .001) and hospitalization (T: 7 days, R: 5 days; P < .001) were shorter in the retroperitoneoscopic group. Ischemia time (T: 24.3 minutes, R: 22.6 minutes) and postsurgical GFR (T: 86.6 vs R: 90.0 mL/min), postsurgical GFR-decrease (T: 7.1%, R: 6.2%, P = .9) and decline of hemoglobin (T: 17.1%, R: 16.6%) were comparable. Complications were 4 nephrectomies (T: n = 1, R: n = 3), 2 revisions for hemorrhage (R: n = 2), 4 pneumothorax (R: n = 4), and 2 urinary fistulas (T: n = 2). The positive surgical margin rate was comparable between groups (T: n = 3, R: n = 5). CONCLUSIONS Transperitoneal laparoscopic and retroperitoneoscopic partial nephrectomy provide comparable surgical and functional results. One advantage of the retroperitoneoscopic access seems to be a shorter total surgical time. |
| Databáze: | OpenAIRE |
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