Category: Laparoscopic/ Robotic: Renal
Introduction & Objective : To describe a novel practical technique for trocar placement in retroperitoneal laparoscopic surgery in treating renal mass in the lower pole.
Methods : Between March 2013 and November 2016, 80 laparoscopic surgery for inferior pole kidney mass were performed in our department. In total, 40 cases were operated with traditional 3 trocar retroperitoneal laparoscopic surgery，40 were treated with an extra trocar. Demographic, perioperative, and postoperative data were recorded. Statistical analyses were performed. Additionally, we described our practical application of extra trocar technique for retroperitoneal approach
Mean age was 61.6 –75.4 years. Mean follow-up was 2.9 – 24.5 months. The trocar placement time was not elongated and no complication caused by extra trocar placement was encountered. No one need open conversion. With this innovation，the surgeon suffered less from the posture when leaning on the patient to fish the retroperitoneal laparoscopic surgery, cosmetic influence was minimal. Besides，the new technique group had a less blood loss (median 130 vs 180 cc), and required shorter warm ischemia time (median 22 vs 28 minutes),operative time were also shorter(median 90 vs110 mins) and hospital stay was the same(median 5.2vs 5.7 days). But the duration of the drainage was shorter（median 2.2vs 3.7 days）.Positive cancer margin occurred in no one. Postoperative serum creatinine level was similar (median 88 vs 95 umol/l).
Conclusions : Our technique with extra trocar seems to be safe and practical for retroperitoneal laparoscopic surgery in treating renal tumor of the lower pole and brings ergonomical superiority which can reduce back and neck pain of the surgeon and assistant
Jianping Wu– vice director, Southeast University Zhongda hospital, nanjing, Jiangsu, China (People's Republic)
Ming Chen– Nanjing, Jiangsu, China (People's Republic)
Lijie Zhang– resident, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China (People's Republic)
Southeast University Zhongda hospital
nanjing, Jiangsu, China (People's Republic)
Vice director of department of urology,Southeast University Zhongda Hospital since 2017