Category: Laparoscopic/ Robotic: Renal
Introduction & Objective :
Retroperitoneoscopic operations are technically more complicated than laparoscopic ones. This is due to the small operating space, the relatively low ergonomics of the working tools, to the more complex intracorporeal sutures, in contrast to laparoscopic access. Manipulation in the retroperitoneal space can be seriously limited when gas enters the abdominal cavity through a peritoneal defect. But this access has a number of undoubted advantages. In addition, in a number of situations it is practically indispensable - for example, in the localization of tumors originating from the posterior lip of the kidney, especially with the spread to the renal sinus.
15 retroperitoneoscopic enucleation of kidney tumors was analyzed. The age of patients was from 22 to 79 years. The sizes of tumors were from 8 to 42 mm. Localization was always the posterior or dorsolateral surface. In 9 cases - the lower and middle segments, in 2 - the upper segment, in 4 patients the tumor started from the posterior lip of the kidney; in 2 of them - with deep penetration into the renal sinus. In 11 observations - T1, in 4 - T3a. In 80% of the observations, preoperative 3D modeling based on multispiral computed tomography was performed, which allows to evaluate the topographic and anatomical relationships of the tumor, vessels of the kidney and the upper urinary tract.
In 9 cases, the kidney wound was not sutured. In 8 - the final hemostasis was carried out by sewing the renal parenchyma with a V-lok thread. Histologically, in 12 cases was found renal cell carcinoma, in 2 cases - oncocytoma, in 1 - angiomyolipoma. The maximum blood loss was 450 ml. Complications: damage of the lower calyx and urinary retention.
Retroperitoneoscopic enucleation of small renal masses which are located primarily on the posterior surface of the kidney is an effective and relatively safe operation. Targeted selection of patients, 3 - D modeling, as well as - increased intracavitary pressure and the principle of controlled hypotension allow the operation to be performed without clamping the renal blood flow.
Mikhail Enikeev– Head of Department, Sechenov University, Moscow, Moskva, Russia
Peter Glybochko– Sechenov University, Moscow, Moskva, Russia
Yuriy Alaev– Sechenov University, Moscow, Moskva, Russia
Leonid Rapoport– Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Evgeniy Shpot– Sechenov University, Moscow, Moskva, Russia
Dmitry Korolev– Sechenov University, Moscow, Moskva, Russia
Andrey Vorobyev– Sechenov University, Moscow, Moskva, Russia
Igor Fokin– Sechenov University, Moscow, Moskva, Russia
Margarita Gaas– Sechenov University, Moscow, Moskva, Russia
Ekaterina Laukhtina– Student, Sechenov University, Moscow, Moskva, Russia
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia