Transperitoneal laparoscopic and robot-assisted resection of anterior and posterior kidney tumors

Abstract

Background. Laparoscopic and robot-assisted resection of the posterior kidney tumors can be performed through retroperitoneal and transperitoneal accesses. Supporters of retroperitoneal partial nephrectomy point to better results for neoplasms in this location. However, most surgeons use transperitoneal access.Aim. To perform comparative analysis of the results of laparoscopic and robot-assisted partial resection of anterior and posterior renal neoplasms.Materials and methods. The results of transperitoneal minimally invasive partial nephrectomy in 156 patients (86 (55.1 %) men and 70 (44.9 %) women) were analyzed. Anterior tumors (1st group) were diagnosed in 96 (61.5 %), posterior (2nd group) in 60 (38.5 %) patients. In the 1st group, mean tumor size was 3.4 ± 1.6 cm; in the 2nd group, 3.2 ± 1.4 cm. In the 1st group, laparoscopic partial nephrectomy was performed in 70 (72.9 %), robot-assisted in 26 (27.1 %) patients; in the 2nd group in 40 (66.7 %) and 20 (33.3 %) patients, respectively. Comparative analysis of operating time, warm ischemia time, complications and glomerular filtration rate was performed.Results. No conversions into nephrectomy or open interventions were performed. Time of laparoscopic partial nephrectomy in the 1st group was shorter than in the 2nd: 108.6 min versus 120.5 min (р >0.05). In robot-assisted partial nephrectomy it was 90.5 and 112.6 min (р >0.05), respectively. For laparoscopic partial nephrectomy, mean warm ischemia time in the 1st group was 15.0 min, in the 2nd group it was 17.5 min (р >0.05); in robot-assisted operation it was 13.2 and 16.0 min (р >0.05), respectively. Blood loss volume was lower in the 1st group compared to the 2nd: 125 ml versus 230 ml (р <0.05). In all patients, renal cell carcinoma was diagnosed; Т1а tumors were predominant (in the 1st and 2nd group, 87.5 and 88.3 %, respectively; р >0.05). Postoperative complications in transperitoneal resection of anterior tumors were observed less frequently: 16.7 % versus 20.0 % (р >0.05). Grade I complications per the Clavien classification in the 1st and 2nd group were observed in 8 (8.3 %) and 6 (10.0 %) patients, grade II in 6 (6.3 %) and 5 (8.3 %) patients, grade III in 2 (2.1 %) and 1 (1.7 %) patients. After resection, urinary leakage through the drain was observed in 2 (2.1 %) patients of the 1st group and 1 (1.7 %) patient of the 2nd group; they underwent drainage of the upper urinary tract using a stent. Blood transfusion in the postoperative period was performed in 2 patients from each group (2.1 and 3.3 %, respectively). In the 1st group, glomerular filtration rate before and after surgery was 68 and 56 ml/min/1.73 m2, in the 2nd group 70.2 and 58.2 ml/min/1.73 m2, respectively; no significant difference was observed (р >0.05).Conclusion. Transperitoneal access allows to safely perform minimally invasive resection of the anterior and posterior kidney tumors with results comparable to the perioperative results of retroperitoneal partial nephrectomy.