Buscar en
Actas Urológicas Españolas (English Edition)
Toda la web
Inicio Actas Urológicas Españolas (English Edition) Laparoscopic partial nephrectomy: Comparative study of the transperitoneal pathw...
Journal Information
Vol. 42. Issue 4.
Pages 273-279 (May 2018)
Share
Share
Download PDF
More article options
Visits
3
Vol. 42. Issue 4.
Pages 273-279 (May 2018)
Surgery Workshop
Laparoscopic partial nephrectomy: Comparative study of the transperitoneal pathway and the retroperitoneal pathway
Nefrectomía parcial laparoscópica: estudio comparativo entre la vía transperitoneal y la vía retroperitoneal
Visits
3
J. Muñoz-Rodríguez
Corresponding author
jesusmunozrguez@hotmail.com

Corresponding author.
, A. Prera, A. Domínguez, L. de Verdonces, M.A. Rosado, R. Martos, J. Prats
Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma, Sabadell, Barcelona, Spain
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Tables (5)
Table 1. Comparison of patient characteristics.
Table 2. Comparison of tumor characteristics.
Table 3. Comparison of the perioperative variables.
Table 4. Comparison of the glomerular filtrate.
Table 5. Classification according to Clavien–Dindo and comparison of complications.
Show moreShow less
Additional material (1)
Abstract
Introduction

Laparoscopic partial nephrectomy is the recommended treatment for tumors smaller than 4cm in cases where it is feasible. Depending on the location of the tumor, the transabdominal or direct retroperitoneal pathway may be considered.

Objective

To compare the transperitoneal (TPPN) and direct retroperitoneal (RPPN) partial nephrectomies performed between 2007 and 2016.

Material and methods

A retrospective study was conducted on 71 patients who underwent TPPN (42) or direct RPPN (29) partial nephrectomy. We evaluated the characteristics of the patients and tumors, including tumor complexity (PADUA, RENAL, C-index). We compared perioperational variables, including the complications between the 2 pathways.

Results

We found no differences in terms of age, sex, Charlson's score and BMI. A larger proportion of patients in the direct RPPN group had prior major abdominal surgery (7.1 vs. 24.1%; p=0.043). There were no differences in tumor size, laterality, polarity or complexity in any of the assessed scores. There were significant differences in tumor location (anterior/middle/posterior) between the TPPN and RPPN groups (54.8/31/14.3 vs. 3.4/13.8/82.8%; p<0.001). There were no differences in the surgical time or length of stay. The TPPN group had a smaller urinary tract opening (4.8 vs. 27.6%; p=0.007) and a higher percentage of haemostatic renorrhaphy (47.6 vs. 17.2%; p=0.008). There were no differences in the need for warm ischemia, in the changes in hemoglobin levels or in the glomerular filtration rate. The complication rates were similar for the two series.

Conclusion

The two pathways show similar results in terms of renal function preservation, complications and oncological results. However, we recommend understanding both techniques and adapting the access type to the clinical case.

Keywords:
Laparoscopy
Partial nephrectomy
Retroperitoneoscopy
Renal tumor
Complications
Resumen
Introducción

La nefrectomía parcial laparoscópica es el tratamiento recomendado en aquellos tumores con un tamaño inferior a 4cm en los cuales sea factible. Dependiendo de la localización del tumor se considerará la vía transperitoneal (VTP) o la vía retroperitoneal directa (VRP).

Objetivo

Comparar las nefrectomías parciales VTP y VRP realizadas entre 2007-2016.

Material y métodos

Estudio retrospectivo de 71 pacientes sometidos a VTP (42) y VRP (29). Se han evaluado características propias de los pacientes y del tumor, incluyendo la complejidad tumoral (PADUA, RENAL, C-index). Se compararon variables perioperatorias, incluyendo las complicaciones, entre ambas vías.

Resultados

No encontramos diferencias en cuanto a edad, género, Charlson o IMC. Encontramos una mayor proporción de pacientes con cirugía mayor abdominal previa en la VRP (7,1 vs. 24,1%; p=0,043). No hallamos diferencias en el tamaño, en la lateralidad ni la polaridad, ni en la complejidad de los tumores en ninguno de los scores evaluados. Encontramos diferencias significativas en la localización del tumor (anterior/medio/posterior) entre la VTP y la VRP (54,8/31/14,3 vs. 3,4/13,8/82,8%; p<0,001). No encontramos diferencias en el tiempo quirúrgico ni en los días de estancia. La VTP presentó una menor apertura de la vía urinaria (4,8 vs. 27,6%; p=0,007) y un mayor porcentaje de pacientes con renorrafia hemostática (47,6 vs. 17,2%; p=0,008). No se encontró diferencia en la necesidad de isquemia caliente, en los cambios en la hemoglobina ni en el filtrado glomerular. La tasa de complicaciones es similar entre ambas series.

Conclusión

Ambas vías muestran resultados similares en cuanto a la preservación de la función renal, las complicaciones y los resultados oncológicos. A pesar de ello, consideramos que es recomendable conocer ambas técnicas y adaptar el tipo de acceso al caso clínico.

Palabras clave:
Laparoscopia
Nefrectomía parcial
Retroperitoneoscopia
Tumor renal
Complicaciones

Article

These are the options to access the full texts of the publication Actas Urológicas Españolas (English Edition)
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Actas Urológicas Españolas (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail
Article options
Tools
Supplemental materials
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Quizás le interese:
10.1016/j.acuroe.2021.06.005
No mostrar más