Safety and efficacy of inferoposterior access approach to the renal pedicle during transperitoneal laparoscopic radical nephrectomy: A retrospective comparative analysis at a single institution

Abstract

Purpose To assess the safety and efficacy of transperitoneal laparoscopic radical nephrectomy using an inferoposterior approach to the renal pedicle. Materials and methods A retrospective review of 89 patients who underwent transperitoneal laparoscopic radical nephrectomy by a single surgeon between June 2014 and December 2019 at a single urological unit was carried out. Access to the renal pedicle was via the inferoposterior approach in 48 cases (study group) and 41 were approached via the conventional anterior approach (control group). Patient demographics, intra-operative anatomical findings, and procedural details including operative time on renal pedicles and post-operative outcomes were recorded. Post-operative complications were recorded and classified according to the Clavien-Dindo classification. A comparative analysis between the two groups was performed using Chi-square test and t-test. Results The inferoposterior approach group had a shorter operative time (132.85±26.65 min vs 153.46±39.94 min; p<0.01), which could be attributed to the shorter time spent operating on the renal vasculature (46.31±6.16 min vs 64.46±7.64 min; p<0.01). Lower average blood loss was also observed in the inferoposterior approach group (42 ml vs 62 ml; p<0.05). No significant difference was identified concerning the mean patient age, body mass index, tumor size, number of renal vessels identified, and post-operative length of stay between the two groups. None of the patients required conversion to open. Conclusion Inferoposterior approach to access the renal pedicle during transperitoneal laparoscopic radical nephrectomy is a safe and effective technique, which shortens the operative time when compared to the conventional anterior approach. Level of evidence: Level 3b.