The laparoscopic radical nephrectomy
The first laparoscopic nephrectomy was performed by Pr R. Clayman in St. Louis USA in 1990 for a non cancerous kidney. Since the laparoscopic nephrectomy is becoming a reference in kidney surgery for begnin or malignant tumors.
Under general anaesthesia, the retroperitoneal space is insufflated and a 10mm ....umbilicus.
Five trocars are placed in the abdominal wound allowing an optimal vision and manipulation of the kidney.
The optic is voice telecommanded.
The kidney is dissected above the colon and the renal artery and vein are ligated and transsected.
The ureter is clipped and the adrenal is removed when the tumor exposes to a high risk of invasion or metastasis (exceptional).
At the end, the kidney is entrapped in a special bag and extracted from the abdomen through a small incision .
A small drain is left in place for 1 or 2 days.
Conversion rate in open surgery : 6% of cases (obese patients or very big tumors) .
The cost of surgery : 70.000 french francs (including fees, room, operating room and intensive care unit, drugs, biological exams and radios). It is a forfait independent of the number of hospitalisation days.
Since 1996, 300 laparoscopic nephrectomies (200 radical and 80 partial) for renal cancer have been done at the Institute Montsouris.
The 80 laparoscopic partial nephrectomies have been performed for small cancers (<6cm).
The average age was 50 years, 60 % men and 40% women.
In 80% of cases the tumor was detected by abdominal ultrasonography without symptoms like hematuria or flank pain.
The operation time 118 minutes (from 45 to 185 mn) the blood loss was 291 ml and the transfusion rate 5% (mostly for the very big tumor or obese patients) ; the post op hospital stay was 4.5 days
No death, no cardiovascular or pulmonary complications.
Oncological results: to day no patient had a local recurrence (0%), two have metastasis (2%).
Functional results: the laparoscopic radical nephrectomy for tumor was never responsible for a renal failure
Hematomas : 6%
Wound infection : 2%
Reoperation rate : 2,5%
( 1 bowel occlusion, 1 wound infection, 2 hematomas, 2 Urinary fistulas, 2 Nephrectomies).
The partial or radical nephrectomy is a routine operation performed in the department of urology
© IMM 2012, social work of 
| Legal Mentions
Contact us | Sitemap |Website realised by Smart Agence
This site complies with the HONcode standard for trustworthy health information:
verify here.