A fast method to identify renal vessels during retroperitoneal laparoscopic nephrectomy

Purpose: To evaluate a fast method to identify renal vessels during retroperitoneal laparoscopic nephrectomy. Methods: One hundred fifty retroperitoneal laparoscopic nephrectomies were performed from October 2003 to June 2006. The renal arteries were identified by following five steps: location, pulling, apophysis, pulsation, and fibrin. Then the renal arteries were severed or ligatured with a linear cutter or Hem-o-lok clips. The renal veins were exposed by dissecting toward the abdominal side under the renal arteries. The management for the renal veins was the same with that of the renal arteries. The fast method to identify the renal vessels during retroperitoneal laparoscopic nephrectomy were evaluated. Results: All 150 procedures were successfully completed, and the renal vessels could be identified in short time. The average time to operation was 90 min (range 45-120 min) with average blood loss of 105 mL (range 10-510 mL). The average specimen weight was 494 g (range 140-890 g). Intake of usual diet and walking were allowed within 3 days for all patients. Drains were removed within 2-4 postoperative days. No patient was converted into an open surgery and blood transfusion. Minor complications were found in 12 cases (8%), and no severe complication occurred in any of the 150 cases. The median time to hospitalization was 6.3 days. Following the five steps, the renal vessels could be identified quickly and easily. The duration of the operations, the risk of conversion to the open surgery, and the vessel injury were decreased. Conclusions: Renal vessels could be identified quickly by the following the five steps during retroperitoneal laparoscopic nephrectomy: location, pulling, apophysis, pulsation, and fibrin. It proved to be a useful method suitable for clinic application.