1. Factors influencing the operating time for single-port laparoscopic radical nephrectomy: focus on the anatomy and distribution of the renal artery and vein
- Author
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Keishiro Fukumoto, Hiroshi Asanuma, Mototsugu Oya, Kazuhiro Matsumoto, Akira Miyajima, Akari Komatsuda, Seiya Hattori, Toshikazu Takeda, Naoya Niwa, and Eiji Kikuchi
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,030232 urology & nephrology ,Nephrectomy ,Renal Veins ,03 medical and health sciences ,0302 clinical medicine ,Port (medical) ,Renal Artery ,Pneumoperitoneum ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Renal artery ,Vein ,Aged ,Retrospective Studies ,Aged, 80 and over ,Kidney ,business.industry ,General Medicine ,Anatomy ,Middle Aged ,medicine.disease ,Surgery ,Dissection ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,Renal vein ,business - Abstract
Objective It is considered that laparoscopic single-site surgery should be performed by specially trained surgeons because of the technical difficulty in using special instruments through limited access. We investigated suitable patients for single-port laparoscopic radical nephrectomy, focusing on the anatomy and distribution of the renal artery and vein. Methods This retrospective study was conducted in 52 consecutive patients who underwent single-port radical nephrectomy by the transperitoneal approach. In patients undergoing right nephrectomy, a 2-mm port was added for liver retraction. We retrospectively re-evaluated all of the recorded surgical videos and preoperative computed tomography images. The pneumoperitoneum time (PT) was used as an objective index of surgical difficulty. Results The PT was significantly shorter for right nephrectomy than left nephrectomy (94 vs. 123 min, P = 0.004). With left nephrectomy, dissection of the spleno-renal ligament to mobilize the spleen medially required additional time. Also, the left renal vein could only be divided after securing the adrenal, gonadal and lumbar veins. In patients whose renal artery was located cranial to the renal vein, PT tended to be longer than in the other patients (131 vs. 108 min, P = 0.070). In patients with a superior renal artery, the inferior renal vein invariably covered the artery and made it difficult to ligate the renal artery via the umbilical approach at the first procedure. Conclusions These findings indicate that patients undergoing right nephrectomy in whom the renal artery is not located cranial to the renal vein are suitable for single-port laparoscopic radical nephrectomy.
- Published
- 2017