Laparoscopic radical nephrectomy (LRN) was first described by Clayman et al. in 1991. Since then, open surgery has increasingly been replaced by laparoscopic approaches. Recent studies have shown that while oncological results and complication rates of open and laparoscopic approaches are similar, laparoscopy is associated with shorter hospital stay and less analgesic requirement, and estimated blood loss. Clayman firstly also described the technique of laparoscopic nephroureterectomy, which was soon replicated by various authors worldwide. However, concerns about the oncological outcome have limited the spread of this technique in the following years. Although many centers perform robotic nephrectomy or partial nephrectomy, very few centers have described the robotic nephroureterectomy. Most surgeons favored the transperitoneal approach because of greater working space and familiar anatomical landmarks. Retroperitoneal LRN is a useful approach in patients of prior abdominal surgeries. However, it may be more challenging to perform retroperitoneal LRN in obese patients. Improper orientation and loss of anatomical landmarks can lead to crucial intraoperative complications. Robot-assisted laparoscopic radical nephrectomy (RLRN) was described in 2000. However, it did not become widespread very quickly due to prolonged operation times, increased operation room costs. In addition, RLRN has similar oncologic outcomes to LRN. The docking and undocking of the robot increase the operative time. In the light of this information, RLRN provides no additional benefits and increases the cost.

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Robotic/Laparoscopic Radical Nephrectomy/Nephroureterectomy

  • Ali Yildiz,
  • Murat Arslan

摘要

Laparoscopic radical nephrectomy (LRN) was first described by Clayman et al. in 1991. Since then, open surgery has increasingly been replaced by laparoscopic approaches. Recent studies have shown that while oncological results and complication rates of open and laparoscopic approaches are similar, laparoscopy is associated with shorter hospital stay and less analgesic requirement, and estimated blood loss. Clayman firstly also described the technique of laparoscopic nephroureterectomy, which was soon replicated by various authors worldwide. However, concerns about the oncological outcome have limited the spread of this technique in the following years. Although many centers perform robotic nephrectomy or partial nephrectomy, very few centers have described the robotic nephroureterectomy. Most surgeons favored the transperitoneal approach because of greater working space and familiar anatomical landmarks. Retroperitoneal LRN is a useful approach in patients of prior abdominal surgeries. However, it may be more challenging to perform retroperitoneal LRN in obese patients. Improper orientation and loss of anatomical landmarks can lead to crucial intraoperative complications. Robot-assisted laparoscopic radical nephrectomy (RLRN) was described in 2000. However, it did not become widespread very quickly due to prolonged operation times, increased operation room costs. In addition, RLRN has similar oncologic outcomes to LRN. The docking and undocking of the robot increase the operative time. In the light of this information, RLRN provides no additional benefits and increases the cost.