Transperitoneal laparoscopic
nephrectomy was integrated into our daily routine within a 6-month period by means of a step-by-step training program progressing from a pelvic trainer to animal studies (N = 15) to laptent-assisted surgery. The
pneumoperitoneum is created with the patient in the flank position, enabling insertion of three
trocars: 10-mm periumbilical (Port I), 5/12-mm subcostal (Port II), and 12/5-mm above the iliac spine (Port III). After medial mobilization of the colon, two additional 5-mm
trocars (Ports IV and V) are inserted into the lateral abdominal wall parallel to Ports II and III. Once clipping and dissection of the ovarian (spermatic) vein has been carried out, the ureter is identified and dissected. Retraction of the proximal ureter exposes the renal hilum, allowing dissection of the renal vessels. The renal vein is dissected using an endoscopic stapling device, while accessory veins and the renal artery are clipped.
Organ retrieval is achieved with a specially designed tissue pouch (Lapsac) and digital fragmentation of the kidney within the organ bag. Using this technique, we have treated 24 patients with benign (N = 20) and malignant (N = 4, including
adrenalectomy) renal disease. The mean
operative time was 239 (115-300) minutes. In four cases, open surgery was required because of
bleeding (N = 2), severe perinephric
inflammation (N = 1), or bowel injury (N = 1). For relief of
wound pain, an average of 1.15 vials of
analgesic (
morphine derivatives)/patient were administered for 2.4 days. The postoperative
hospital stay averaged 6.2 (4-10) days.