Objective To evaluate the outcomes of laparoscopic live donor nephrectomy via retroperitoneal approach. Methods From December 2003 to June 2004,6 patients underwent laparoscopic live donor nephrectomy (younger brother to elder sister in 1 case,elder brother to younger brother in 1, younger sister to elder brother in 1,elder sister to younger brother in 1,father to son in 1,mother to son in 1).For tissue matching,1 case was mismatched of 0 locus,2,of 2 loci and 3,of 3 loci.The results of PRA and lymphocytotoxicity test were negative.The patient was placed in the lateral decubitus.With 3 trocars, the left kidney was dissected via retroperitoneal approach.The arteries and veins were cut off by endoscopic articulating linear cutter. The donor's left kidney was taken out through a 6-7 cm long incision between 2 trocars.Staplers on renal arteries and veins were cut off,and the donor kidney was perfused with liquid,and then was implanted at the right iliac fossa of the recipients.Triple immunosuppressant therapy was used to prevent rejection. Results Laparoscopic donor nephrectomy was successfully performed on all the 6 cases by retroperitoneal approach.The kidney transplantations using the donor live kidneys were also successful.Postoperatively,the mean urine volume was 5036 ml(range,3500-6500 ml) on the first day;the mean serum creatinine level was 598 ?mol/L on the first day and 129 ?mol/L at 1 month.Follow-up of 3-9 months showed that the renal function was normal and no rejection occurred. Conclusions Laparoscopic donor nephrectomy via retroperitoneal approach is safe,feasible,and less invasive to the donor; however,this technique needs skilled surgeons of laparoscopy and renal transplantation.

Objective To evaluate the safety and efficacy of retroperitoneoscopic radical nephrectomy. Methods A total of 46 patients (24 males and 22 females;age range,23-86 years;mean age,58 years) underwent retroperitoneoscopic radical nephrectomy from November 2002 to July 2004.Of the 46 cases,43 were detected by B-ultrasound during physical examination and the rest 3,when visiting doctors due to painless hematuria.The masses by B-ultrasound was on average 4.5 cm (range,1.5-8.0 cm) in diameter, with 17 masses at the upper pole of the kidney,13 at the middle and 16 at the inferior pole.CT scan was performed on all the 46 cases and MRI,on 41.The tumor size detected by CT and MRI was consistent with that by B-ultrasound.Preoperatively,3 cases had the tumors of clinical stage T 1N 0M 0,38 of T 2N 0M 0 and 5 of T 3aN 0M 0. Results The operative time was 60-255 min (mean,145 min),and blood loss was 20-1000 ml (mean,133 ml).Adrenalectomy was performed on 32 patients (70%).Complications occurred in 3 cases,of whom only 1 required conversion to open surgery due to injury of genital gland vein,with blood loss of 1000 ml.Pathology showed that 41 cases were of renal clear cell carcinoma,2 of cystic renal cell carcinoma,1 of chromophobe carcinoma,1 of hamartoma and 1 of oxyphil cell tumor.During the follow-up of 1-20 months (mean,9 months),45 patients survived;only 1 died of liver metastasis. Conclusions Retroperitoneoscopy radical nephrectomy is safe and effective.

Objective To evaluate the efficacy of retroperitoneal laparoscopic radical nephrectomy.Methods A total of 126 patients underwent retroperitoneal laparoscopic radical nephrectomy from November 2002 to June 2006.The operation was performed through 3 lumbar ports.The renal artery and veins were blocked with the Hem-o-lok and then severed;the ureter was severed near the iliac blood vessel.Results A conversion to open surgery was required in 2 patients because of bleeding and in 1 patient because of severe adhesion.The mean operation time was 115 min(range,60~255 min) and the mean blood loss was 112ml(range,20~1000 ml).Blood transfusion was required in 2 patients.Complications occurred in 7 patients(spermatic vein injury in 1 patient,accessory renal artery injury in 1 patient,inferior vena cava injury in 1 patient,hemorrhage of renal artery stump in 1 patient,renal vein injury in 2 patients,and pancreatic tail injury in 1 patient).The patient with inferior vena cava injury was followed for 2 years and no abnormal findings were found.The patient with pancreatic tail leakage was followed for 1 year and no pancreatitis or liquid in the renal fossa was detected.The remaining 5 patients with complications presented no abnormal findings.The mean postoperative hospital stay was 5 days(range,4~8 days).Pathological results included renal clear cell carcinoma in 117 patients,cystic renal cell carcinoma in 3 patients,renal pelvis transitional cell carcinoma in 2 patients,chromophobe carcinoma in 1 patient,hamartoma in 2 patients,and oxyphil cell tumor in 1 patient.One patient developed a liver metastasis 6 months after operation,and died 1 year after operation.The rest of 125 patients were followed for a mean of 27 months(range,1~43 months),and survived without renal fossa or incision metastasis,or distant recurrence.Conclusions Retroperitoneal laparoscopic radical nephrectomy is a safe,reliable,and effective technique for renal tumors.

Objective To summarize the complications of retroperitoneal laparoscopic nephrectomy.Methods From November 2002 to May 2006,122 patients with renal carcinoma underwent retroperitoneal laparoscopic nephrectomy.Complications occurred in 7 patients,and the morbidity was 5.7%.One case of injury to vena spermatica converted to open surgery,the blood loss was 1000 ml with blood transfusion 800 ml.One postoperation hemorrhage of accessory renal artery which was cut off only by harmonic scalpel,leading to blood pressure decrease to 90/60 mm Hg,and a reoperation was performed and the blood loss was 600 ml with blood transfusion 400 ml.Injury of inferior vena cava by linear cutter stapler in one case,and there was no blood loss.Hemorrhage of renal artery stump after linear cutter stapler in one case and it was controlled by titanium clip.Injury of renal vein occurred in two cases and all were controlled by Hem-o-lok or titanium clip.Injury of tail of pancreas in one case and a drainage tube was placed.Results A patient with vena cava injury was followed for 30 months and no abnormality was noted.A patient with pancreas injury was followed for 1 year and nothing remarkable was noted.The other 5 cases was followed for 20-40 months,and they remained in good health.Conclusion The major complication for retroperitoneal laparoscopic surgery is injury to large blood vessels,the principle of treatment is to elevate the pressure of pneumoperitoneum up to 18-20 mm Hg and clip the blutpunkte or convert to open surgery promptly.A good drainage is necessary for the treatment of injury of pancreas.

Objective To evaluate the clinical efficacy of retroperitoneoscopic surgery for adrenal cyst.Methods From May 2002 to December 2006,retroperitoneoscopic surgery was performed in 12 cases of adrenal cyst.The diameter of cyst was ranged from 3.6 cm?2.2 cm-10.0 cm?8.0 cm.After the retroperitoneal space was dilated,the perinephric fascia was opened.The adipose tissues around the upper polar of the kidney and the adrenal gland were dissected.Then the upper polar of the kidney and the cyst of adrenal gland were separated along the renal surface with a ultrasound scalpel.The cysts and normal adrenal tissue 1 cm away from the cysts were resected.Results The operation was successful in all of 12 patients without conversion to open surgery.The mean operative time was 65 min(range,50-120 min);the mean blood loss was 45 ml(range,10-150 ml);the mean hospital stay was 4.5 days(range,3-7 days).Intraoperative cyst rupture occurred in 2 cases of larger cysts,then the cystic fluid was drawn out and the cyst wall was fully excised.No incision infections occurred.A follow-up period of 2-55 months(mean,32 months) in 12 patients showed no cysts recurrence.Conclusions Retroperitoneoscopic surgery for adrenal cyst has the advantages of minimal invasion,less blood loss,quicker recovery,and shorter hospital stay,therefore it provides the first choice for adrenal cyst.

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Objective To explore the techniques and efficacy of retroperitoneal laparoscopic operations in the treatment of renal cyst. Methods A total of 35 patients were operated on under general anesthesia. A water-filled balloon was used to dilate the retroperitoneal cavity. The renal cyst was exposed by identifying the psoas major muscle, peritoneal reflection, pillar of diaphragm and so on. All cyst walls were unroofed with ultrasonic scalpel 3～5 mm from the edge of renal parenchyma. Results With renal cysts removed, the operations were successfully accomplished in all the 35 patients. The operation time was 15～60 min (mean, 32 min). The intraoperative blood loss was 5～60 ml (mean, 35 ml). The postoperative hospital stay was 3～6 days. Pathological examinations reported benign lesions in 34 patients and suspected cystadenocarcinoma in 1 patient. All the 35 patients were followed for 1～22 months. No recurrence was found with exception of 1 case of remaining renal cyst 1.5 cm in diameter under B-ultrasonography at the first postoperative month. The patient with suspected adenocarcinoma had been followed for 1 year and no evidences of neoplasm or metastasis were detected on the chest roentgenogram and B-ultrasonography of the liver and the kidneys. Conclusions Retroperitoneal laparoscopic unroofing is a safe and effective procedure for renal cyst.

Objective To evaluate the feasibility and curative effects of retroperitoneal laparoscopic surgery for adrenal pheochromocytoma. Methods Clinical records of 9 cases of retroperitoneal laparoscopic adrenalectomy of pheochromocytoma from October 2002 to November 2004 were reviewed. Results The operations were successfully completed in all 9 cases without severe complications. A sudden rise of blood pressure with an amplitude over 30 mmHg appeared in 3 cases during the operation, which took a favorable turn after adjusting the surgical performance and blocking the central vein. The operation time was 90~210 min (mean, 150 min). The intraoperative blood loss was 30~150 ml (mean, 50 ml). Blood transfusion was required in no cases. The postoperative length of hospitalization was 4~9 days (mean, 5 days). Pathological examination revealed benign adrenal pheochromocytoma in all cases. Follow-up for 3~24 months (mean,11 months)in the 9 cases found symptom free and no recurrence by B-ultrasonography or CT scans. Conclusions Retroperitoneal laparoscopic surgery for adrenal pheochromocytoma is a feasible procedure which offers advantages of minimal invasion, short operation time, less blood loss, quick postoperative recovery, fewer complications and good curative effects, having a promising future.