A modified adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy

Abstract

BackgroundThe objective of this study was to modify the adrenal gland-sparing strategy based on retroperitoneal laparoscopic radical nephrectomy by reviewing the anatomic relationship between the kidney and the adrenal gland.MethodsFrom June 2010 to October 2012, a total of 68 patients (45 males and 23 females) with localized renal cell carcinoma were treated at our hospital. The study included 35 cases that were right side and 33 cases that were left, and average patient age was 54.06 years. The average tumor size was 4.7 cm. Tumors were classified via the TNM staging system. All patients underwent adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy.ResultsFor each patient, surgery was successful without conversion to open surgery. The average operative time was 56.65 ± 26.60 min, and the mean blood loss was 70.61 ± 60.96 ml. All patients were discharged from the hospital 3 to 8 days after surgery. During surgery, the adrenal gland was slightly lacerated in three cases and the peritoneum showed perforation in six cases. Only one case recurred during the study follow-up.ConclusionsBased on retroperitoneal laparoscopy radical nephrectomy, this effective adrenal gland-sparing surgery showed direct exposure of tissue and little interference of the upper pole of the kidney. Elevation of the adrenal gland could help with the complete dissection of the adrenal gland from the kidney. The separation of the kidney was rapid, simple and accurate. The probability of adrenal gland damage was reduced. This strategy is recommended for widespread use in T1-2 renal neoplasms.

A Study of Fascia and Space Anatomy Layers about Adrenal Gland-Sparing in Retroperitoneal Laparoscopic Radical Nephrectomy

“…Particularly attention is that the right adrenal central vein converged with the inferior vena cava, while the left adrenal central vein converged into the left renal vein [9]. In traditional process, adrenal gland was separated in three above planes, we need incided perirenal fat on the abdominal side of upper of kidney, and separated in relatively bloodless planes between the bottom of the adrenal gland and the upper of kidney [10]. However, a disadvantage of this technique might be could not avoid the influence of the upper pole of the kidney.…”