A Study On The Application Of Endoscopic Tissue Morcellator In Retroperitoneal Laparoscopic Surgery

Purpose:The purpose of this study is to evaluate the safety and clinical value of retroperitoneal fat removal by using an endoscopic tissue morcellator in retroperitoneal laparoscopic surgery as an example of localized renal cancer surgery.Methods:From December 1^st,2018 to December 31^st,2021,a total of173 cases with localized kidneys requiring retroperitoneoscopic radical nephrectomy（RRN）or retroperitoneoscopic partial nephrectomy（RPN）were prospectively included according to the inclusion and exclusion criteria of this study.The patients were firstly divided into the obese group（BMI≥28）and the non-obese group（BMI<28）,and then randomly divided into the experimental group（RRN/RPN with ETM）and the control group（traditional RRN/RPN）by using random number table method.The operation time,warm ischemia time（only in RPN）,intraoperative blood loss,the occurrence of surgical complications,retroperitoneal drainage volume,hospitalization time,overall survival,and other clinical indicators were compared in experimental and control groups respectively,and SPSS 25.0 was applied for statistical analysis.Results:There were no significant differences in baseline data such as age,weight,BMI,anesthesia ASA grade,tumor location,tumor size,and preoperative serum creatinine among the obese or non-obese patients in the study（P>0.05）.In the RRN group,the operation time and intraoperative blood loss of the experimental group were shorter than those of the control group only in the obese group,and the differences were statistically significant（P<0.05）.In the RPN group,the operation time and warm ischemia time of the experimental group were significantly shorter than those of the control group only in the obese group,and the differences were statistically significant（P<0.05）.There were no statistically significant differences in other clinically relevant indicators.Whether the use of ETM in RRN or RPN had no significant effect on the occurrence of surgical complications,retroperitoneal drainage volume,hospitalization time,and overall survival（P>0.05）.No atypical tumor cells were found in the histopathological analysis of retroperitoneal adipose tissue aspirated by using ETM.Conclusion:In this study,laparoscopic localized renal cancer surgery was taken as an example.Especially for obese patients,compared with traditional retroperitoneal laparoscopic surgery,the improved retroperitoneal laparoscopic surgery with endoscopic tissue morcellator has the advantages of shortening operation time and warm ischemia time,reducing intraoperative blood loss,and expanding the operation space,which are beneficial to the operation of the surgeons.It has also been proven to have a certain degree of safety.It is worthy of further promotion in the application of retroperitoneal laparoscopic surgery.