Transperitoneal laparoscopic nephrectomy

Objectives : to evaluate the feasibility and complications of transperitoneal laparoscopic nephrectomy. Material and Methods : 30 transperitoneal laparoscopic nephrectomies were performed between November 1992 and October 1998 : 17 for malignant lesions (10 renal cell carcinomas, 7 urothelial tumours) and 13 for benign lesions. Results : the operation was performed entirely by laparoscopy in 25 cases, with 4 conversions: 3 for technical problems (difficulties of dissection: 1, haemorrhage: 2). One patient underwent laparotomy on the same day and three patients were transfused. The mean operating time was 116 minutes. No laparoscopy-specific complications were observed. Conclusion : a standard technique must be performed regardless of the disease: systematic open laparoscopy, wide colonic dissection, exposure of the vessels and resection in the plane of the radical nephrectomy. The risk of cancer dissemination with laparoscopy appears to be non-existent for renal cell carcinomas and controversial for urothelial tumours. Complications were always benign, although there is always a risk of bleeding, regardless of the operator's experience. The current technical conditions of laparoscopic surgery and its extension to all forms of visceral surgery should encourage the use of this technique by urologists, particularly for renal surgery.