Comparison Of Transperitoneal Vs Retroperitoneal Laparoscopic Simple Nephrectomy

Objective: to analyze the perioperative clinical data of transperitoneal laparoscopic simple nephrectomy(TLSN)and retroperitoneal laparoscopic simple nephrectomy(RLSN),and to compare the efficacy of TLSN and RLSN in the treatment of benign kidney diseases.Methods: The clinical data of transabdominal and retroperitoneal laparoscopic simple nephrectomy performed by the same operator in the first affiliated Hospital of Guangxi Medical University from January 2016 to December 2020 were collected and analyzed.There were 27 patients in the transabdominal approach group,including 12 males and 15 females.The average age was 48.19 ±13.58 years old,13 on the left and 14 on the right,and18 in the retroperitoneal approach group,including 6 males and 12 females,with an average age of 48.22 ±15.68 years.There were 11 cases on the left side and 7cases on the right side.The general indexes such as sex,age,body mass index(body mass index,BMI),size of kidney,lesion side and hemoglobin before operation were compared between the two groups.Intraoperative indicators:operation time(operation time,OT),intraoperative blood loss(estimated blood loss,EBL),whether or not blood transfusion,the number of cases converted to open,intraoperative complications.Postoperative indicators: postoperative hemoglobin,postoperative intestinal recovery time,indwelling time of drainage tube,visual analogue pain score(visual analog pains coring,VAS)on the first and second day after operation,postoperative hospital stay,operation cost.And postoperative complications,the results were compared and analyzed.Results: There was no significant difference in general indexes(age,sex,BMI,size of kidney,lesion side,preoperative hemoglobin)between the two groups(P > 0.05).There was no perioperative death in RLSN group and TLSN group.In RLSN group,3 cases were converted to open surgery because of perirenal adhesion,and 1 case in TLSN group.There was no significant difference in OT,EBL,postoperative intestinal recovery time,postoperative drainage tube indwelling time,postoperative hemoglobin,VAS on the second day and postoperative hospital stay in vs RLSN group in TLSN group.There were significant differences in the time of using painkillers,the cost of operation and VAS on the first day after operation(P < 0.05).There were no intraoperative complications in both groups.There were 3 cases of abdominal distension and 1case of fever in TLSN group(2 cases of fever caused by renal tuberculosis in),RLSN group(1 case of incision infection and 1 case of renal tuberculosis).There was no significant difference between the two groups(P > 0.05).Conclusion: 1.Transperitoneal approach and retroperitoneal approach for laparoscopic simple nephrectomy are effective,safe and feasible for the treatment of non-functional kidney.2.The time of using painkillers after retroperitoneal approach is shorter than that of laparoscopic simple nephrectomy.3.The cost of retroperitoneal approach is less than that of laparoscopic simple nephrectomy.4.There is no significant difference between the two approaches in terms of postoperative efficacy and postoperative complications,and surgical methods can be chosen according to the specific conditions of the patients and the surgical experience of the operators.