Factors influencing the operating time for single-port laparoscopic radical nephrectomy: Focus on the anatomy and distribution of the renal artery and vein

Kazuhiro Matsumoto, Akira Miyajima, Keishiro Fukumoto, Akari Komatsuda, Naoya Niwa, Seiya Hattori, Toshikazu Takeda, Eiji Kikuchi, Hiroshi Asanuma, Mototsugu Oya

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)976-980
Number of pages5
JournalJapanese journal of clinical oncology
Volume47
Issue number10
DOIs
Publication statusPublished - 2017 Oct 1

Keywords

  • LESS
  • Laparoscopic radical nephrectomy
  • Renal artery
  • Renal vein
  • Single-port

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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