PTU - Polskie Towarzystwo Urologiczne
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Retroperitoneal laparoscopic tumorectomy as duplication of the technique of open procedure
Article published in Urologia Polska 2008/61/Supl. 1.


Marcin Słojewski, Marcin Gałęski, Artur Lemiński, Adam Goł±b, Piotr Petrasz, Andrzej Sikorski
Katedra i Klinika Urologii PAM w Szczecinie



Laparoscopic techniques have been used successfully in the treatment of upper urinary tract neoplasms. The most popular procedure is radical nephrectomy performed both with transperitoneal and retroperitoneal approach. Laparoscopic nephron-sparing surgery (LNSS), whose history goes back to the early nineties of the 20thC, starts to be more often employed. The development of this method was limited to a small number of centers mostly due to technical and surgical problems with hemostasis control. Originally, the indications were restricted to selected cases of small, peripherally located tumors. Along with gained experience and the advance of
hemostatic agents, such operations are performed more often, but still are considered to be technically difficult. In order to achieve the best oncological results this procedure should duplicate the open technique.


The video presents the technique of organ-sparing resection of renal tumor which is used in our center. The case of 31 years-old woman with 5cm solid tumor of the middle part of the left kidney is presented. Each step of the operation is showed and the possible technical problems are pointed out.

Materials and methods.

In our center we routinely employ the retroperitoneoscopic access with 3 or 4 trocars and the patient being placed in lateral position. The kidney is precisely mobilized from surrounding fatty tissue, but the capsule covering the tumor is left intact. The upper ureter and hilar vessels are dissected for clamping or securing in case when the decision about nephrectomy is minded. After localization of tumor margins the line of cutting is marked with J-hook electrocautery. Then, depending on indications, pedicle is clampped with intestinal or laparoscopic Satinsky clamp. Tumor is excised with cold scissors with the margin of normal parenchyma. The repair of pelvicalyceal system entry is performed with single or running suture. The tightness is checked with retrograde injection of indigo carmin. The lodge of the
tumor is coagulated with monopolar or argon-beam electrocautery. In case of larger tumors the renal parenchyma is reconstructed with running suture with a hemostatic bolster. The tumor is placed in a plastic bag and removed. The hilar clamp is released and the hemostasis controlled.


We have performed operations in several dozen of patients in an identical or similar way. The results are presented in a separate paper. In the described above case the operation time was 100 minutes, and the blood loss was evaluated for 50ml. Pathological examination revealed chromophobic carcinoma with negative surgical margins.


1. The technique used by us is duplication of the open procedure. 2. LNSS might be a valuable alternative for open procedures in well-equipped centers with experienced personnel. This study has been financed by 2007-2010 scientific grant for research projects.