OBJECTIVETo review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy (RLPN) with transperitoneal laparoscopic partial nephrectomy (TLPN) and provide reference for clinical work.

METHODSThe search strategy was performed to identify relevant papers from the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Google Scholar, China Hospital Knowledge Database, Wangfang Chinese Periodical Database, and VIP Chinese Periodical Database. All papers comparing RLPN with TLPN were included from 2000 to 2015. Two to three reviewers independently screened, evaluated, and extracted the included papers. A Meta-analysis was executed by using Review Manager 5.3 software. The interesting outcomes were tumor size, operating time, estimated blood loss, warm ischaemia time, length of hospital stay, positive margin rate, open conversion rate, overall complication rate, and recurrence rate.

RESULTSThe literature search obtained 378 papers, then 10 of them were ultimately met the inclusion criteria and included in the systematic review. Finally, 6 of the 10 papers were included in the Meta-analysis. RLPN had significantly less operating time [P = 0.01, mean difference (MD)=-33.68, 95% confidence interval (CI) within (-60.35, -7.01)] and shorter length of hospital stay [P < 0.0001, MD=-1.47, 95% CI within (-2.18, -0.76)] than TLPN. Significant differences were not found between RLPN and TLPN in other outcomes.

CONCLUSIONSRLPN may be equally safe and be faster than TLPN. Each center can choose a modality according to your own operating habits and experience.

Humans ; Laparoscopy ; methods ; Nephrectomy ; methods ; Peritoneum ; Publication Bias ; Retroperitoneal Space

OBJECTIVE[corrected] To evaluate the method and technique of single-port laparoscopic radical nephrectomy.

METHODSForm January 2009 to September 2011, 22 patients with renal carcinoma were treated with single-port laparoscopic radical nephrectomy. An incision about 5 cm in length was made through the umbilicus or in the postaxillary line under the 12th rib to establish the peritoneal or retroperitoneal working space. A single-port cannulation was deployed and the operation was carried out using standard and crooked laparoscopic equipment.

RESULTSThe operations were completed successfully in all the 22 cases without conversion to open surgery, but additional trocar was needed in 5 cases. The mean operative time of radical nephrectomy was 150 min (90-240 min). The mean postoperative hospital stay was 7.6 days (3-15 days). The operation left a roughly 5-cm-long scar in all the cases.

CONCLUSIONSingle-port laparoscopic radical nephrectomy is safe and feasible with good cosmetic effect and shows much potential in radical resection of renal carcinoma.

Adult ; Aged ; Female ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Young Adult

Adult ; Female ; Humans ; Kidney Transplantation ; Laparoscopy ; methods ; Living Donors ; Male ; Middle Aged ; Nephrectomy ; methods

BACKGROUNDOver the past two decades, the clinical presentation of renal masses has evolved, where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer. This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA).

METHODSThe US National Library of Medicine's life science database (Medline) and the Web of Science were exhaustly searched before August 1, 2013. Clinical stage 1 SRMs that were treated with PN or RFA were included, and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed.

RESULTSPatients who underwent RFA were significantly older (P < 0.001). In the subanalysis of stage T1 tumors, the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN): 7.2%, open partial nephrectomy (OPN): 7.9%, RFA: 3.1%, both P < 0.001). Minor complications occurred more frequently after RFA (RFA: 13.8%, LPN/RPN: 7.5%, OPN: 9.5%, both P < 0.001). By multivariate analysis, the relative risks for minor complications of RFA, compared with LPN and OPN, were 1.7-fold and 1.5-fold greater (both P < 0.01), respectively. Patients treated with RFA had a greater local progression rate than those treated by PN (RFA: 4.6%, LPN/RPN: 1.2%, OPN: 1.9%, both P < 0.001). By multivariate analysis, the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater, respectively (both P < 0.001).

CONCLUSIONSThe current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs. Compared with PN, RFA showed a greater risk of local tumor progression but a lower major complication rate, which is considered better for poor candidates. PN is with no doubt the golden treatment for SRMs, and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists. RFA may be the best option for select patients with significant comorbidity.

Catheter Ablation ; adverse effects ; methods ; Humans ; Kidney Neoplasms ; surgery ; therapy ; Nephrectomy ; adverse effects ; methods

OBJECTIVETo evaluate the safety and efficacy of single-port transumbilical laparoscopic nephrectomy.

METHODSFrom December 2008 to August 2009, we have performed three cases of single-port transumbilical laparoscopic nephrectomy of nonfunctioning renal by Tri-Port system. Among three patients there were two cases of UPJO and one case of upper ureteral obstruction. Involved kidneys were not visualized in IVU and the GFR were not more than 0.90 ml/s. Tri-Port system was inserted transperitoneal through a 2 cm umbilical incision. The flexible grasper, scissors were used in addition to standard laparoscopic equipment. Renal pedicle was divided by Endoscopic Linear Stapling device. Specimens were extracted through the incision.

RESULTSThe first and second case were successful, and the operation time were 85 min and 165 min. The bleeding volume were 50 ml and 100 ml. The discharge time after operation was 3 days and 5 days, respectively. The third case was converted to open surgery because of the edema and adhesion of renal pedicle. At 3 weeks of follow-up, the incisions were hidden in the umbilicus with good cosmetic benefit.

CONCLUSIONSThis new method is technically feasible, which combined with these advantages of less trauma and more cosmetic benefit. However, more special instruments and long learning curving may be needed for those surgeons, who are going to carry out it.

Adult ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Treatment Outcome ; Umbilicus ; surgery

Adult ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; methods ; Male ; Nephrectomy ; methods ; Retroperitoneal Space ; surgery

Since its introduction 6 years ago, almost all abdominal procedures have been attempted laparoscopically. Despite their retroperitoneal location, kidneys and adrenals have also been reached by the blitz of endoscopic surgery since 1992. We present here the techniques, indications, advantages or disadvantages of the videoscopic approach-either laparoscopic or retroperitoneoscopic- of those solid retroperitoneal organs. Preliminary results of the international literature are presented, while objectively comparing currently available data about the efficacy and cost of endoscopic versus open procedure. Despite the time-consuming nature and high operative cost of the endoscopic approach, decreased convalescence and better patient comfort are evident. Furthermore videoendoscopic adrenal surgery performed, even sporadically, by surgeons experienced in laparoscopic surgery is as safe as the open approach, provided that those surgeons are also familiar with the rules and potential drawbacks of adrenal surgery for endocrine disorders.
Adrenalectomy ; economics ; methods ; Cost-Benefit Analysis ; Endoscopy ; economics ; methods ; Humans ; Laparoscopy ; economics ; methods ; Nephrectomy ; economics ; methods ; Retroperitoneal Space

This study aimed to determine patients with T1b renal cell carcinoma (RCC) who could benefit from partial nephrectomy (PN) and method to identify them preoperatively using nephrometry score (NS). From a total of 483 radical nephrectomy (RN)-treated patients and 40 PN-treated patients who received treatment for T1b RCC between 1995 and 2010, 120 patients identified through 1:2 propensity-score matching were included for analysis. Probability of chronic kidney disease (CKD) until postoperative 5-years was calculated and regressed with respect to the surgical method and NS. Median follow-up was 106 months. CKD-probability at 5-years was 40.7% and 13.5% after radical and PN, respectively (P = 0.005). While PN was associated with lower risk of CKD regardless of age, comorbidity, preoperative estimated renal function, the effect was observed only among patients with NS ≤ 8 (P < 0.001) but not in patients with NS ≥ 9 (P = 0.746). Percent operated-kidney volume reduction and ischemia time were similar between the patients with NS ≥ 9 and ≤ 8. In the stratified Cox regression accounting for the interaction observed between the surgical method and the NS, PN reduced CKD-risk only in patients with NS ≤ 8 (hazard ratio [HR], 0.054; P = 0.005) but not in ≥ 9 (HR, 0.996; P = 0.994). In T1b RCC with NS ≥ 9, the risk of postoperative CKD was not reduced following PN compared to RN. Considering the potential complications of PN, minimally invasive RN could be considered with priority in this subgroup of patients.
Carcinoma, Renal Cell ; Comorbidity ; Follow-Up Studies ; Humans ; Ischemia ; Methods ; Nephrectomy* ; Propensity Score ; Renal Insufficiency, Chronic

Currently, partial nephrectomy for patients with malignant renal tumors has become the procedure of choice for elective indications. Attempts have been made to use minimally invasive endoscopic procedures to replace the standard open partial nephrectomy. Laparoscopic partial nephrectomy can be technically challenging and be associated with vascular complications such as pseudoaneurysm. We report here on a case of renal artery pseudoaneurysm that occurred after laproscopic partial nephrectomy for renal cell carcinoma treated by percutaneous selective angioembolization.
Aneurysm, False* ; Carcinoma, Renal Cell* ; Humans ; Laparoscopy ; Methods ; Nephrectomy* ; Renal Artery*

Humans ; Kidney ; blood supply ; Nephrectomy ; methods ; Reperfusion Injury ; prevention & control ; Time Factors ; Warm Ischemia