A Comparative Study Of Laparoscopic Transperitoneal And Retroperitoneal Approaches Simple Nephrectomy

Objective:To retrospective investigate the clinical indicator of transperitoneal and retroperitoneal approaches laparoscopic simple nephrectomy.To evaluate clinical value transperitoneal and retroperitoneal approaches laparoscopic simple nephrectomy.Methods:Between March2011to December2012, a total of52patients with simple nephrectomy were involved.22cases undergoing transperitoneal(TP) approache including12male and10female, aged from18to63yeas old, mean age is47.23±12.27years old,14cases are left,8cases are right.30cases undergoing retroperitoneal(RP) approache including18male and12female aged from20to74yeas old, mean age is years48.10±10.56old,16cases are left,14cases are right. Age,gender,BMI,the sides of operation,case type, the duration of operation, intraoperative blood loss, cases of intraoperative blood transfusion,incision total length, intraoperative complications, postoperative drainage volume, postoperative intestinal function recovery time, time of postoperative drainage, time to ambulation,postoperative complications, satisfaction score of incision, postoperative hospital stay, cases of postoperation analgesia, follow-up information were compared between the two groups.Results:All operations of the two groups were performed successfully. None of two Group experienced conversion to open surgery.Mean operating time was165.90±27.11min(TP) vs138.40±35.61min(RP), intraoperative mean estimated blood loss was121.73±81.34mL(TP) vs93.50±15.15mL(RP), intraoperative blood transfusion2cases(TP) vs1case(RP),incision total length was4.95±0.74cm (TP) vs5.10±0.59cm (RP), postoperative mean drainage volume was146.15±97.47mL (TP) vs202.33±80.52mL (RP) postoperative mean intestinal function recovery time was3.14±0.89d (TP) vs2.18±0.87d (RP), mean time of postoperative drainage was2.59±0.59d (TP) vs2.35±0.57d(RP), time to mean ambulation2.90±0.68d(TP) vs2.60±0.62d (RP), satisfaction score of incision was3.63±0.56(TP) vs2.35±0.86(RP), mean hospital stay was9.23±1.80d (TP) vs6.02±1.07d (RP), in transperitoneal group2cases of postoperation analgesia. Complications include2patients with injured vessels(2cava),2ones subcutaneous emphysema,2ones with hypercapnia,1patient with incision infection. In retroperitoneal group7cases of postoperation analgesia. Complications include1patient with injured vessels(1cava),11ones subcutaneous emphysema,2ones with hypercapnia,2patients with incision infection. The patients were followed up for3-12months.B-ultrasound or IVU showed no abnormality seen in all patients.Results:Showed that there were no significant differences between the2groups (age,gender,BMI,the sides of operation,case type), no significant differences between the2groups in terms of intraoperative estimated blood loss, incision total length,complications,mean time to ambulation,postoperation analgesia(P>0.05).There were significant differences between the2groups in terms of operating time, postoperative mean intestinal function recovery time、postoperative mean drainage volume、satisfaction score of incision, postoperative mean hospital stay (p<0.05).Conclusions1.Transperitoneal and retroperitoneal laparoscopic simple nephrectomy were safe and reliable.2.Transperitoneal laparoscopic simple nephrectomy incision was hidden better cosmesis than retroperitoneal.3.The operating time of retroperitoneal laparoscopic simple nephrectomy was less than transperitoneal.4.The hospital stay and intestinal function recovery time of retroperitoneal laparoscopic simple nephrectomy was shorter than transperitoneal.