Mediathek

Abstract

F. Heining¹, U. Bieri¹, P. Maletzki¹, J.-P. Adank¹, N. Lautenbach¹, C. Tschung¹, L. Hefermehl^1
1Kantonsspital Baden, Urologie, Baden, Schweiz

Background: The transabdominal approach (TA) for total (TN) and partial nephrectomy (PN) has been widely adapted. The retroperitoneal approach (RPA) has gained popularity because the renal artery is often found fast due to the trocar position in the lumbar line. However, both approaches face difficulties: Trocar placements for RPA require a balloon and can be challenging because the working space is often limited. In case of TA the dissection of the renal artery can be challenging due to the anatomic localization dorsally to the renal vein. We have have introduced a novel technique at our department that combines the advantages of TA and RPA: The transabdominal lumbar approach (TALA).

Methods: In TALA the first three trocars are placed in the lumbar line transabdominally with a slight triangulation. Inscision of the peritoneum following the Toldt‘s line, colon mobilization and elaboration of the retroperitoneal cavity is performed using a conventional laparoscopic technique. Then two additional 8mm DaVinci trocars are placed in the former retroperitoneum following the lumbar line. Additionally a 12mm assistant trocar is placed before the robot is docked.

Results: 20 patients underwent renal surgery by TALA with a m edian age of 65 years, and a mean BMI of 27,4 kg/m2 (6 female, 14 male; 9 TN, 11 PN). Median operation time was 202 minutes with a median blood loss of 197ml and a median hospital stay of 6 days. There were two complications of category 3 according to Clavien-Dindo (1 infected hematoma with consecutive puncture, 1 gastric ulceration with hemorrhage) and one category 4 (Duodenal ulceration with consecutive surgical suturing 14 days postoperatively).

Conclusion: TALA is a promising approach for renal surgery combining the advantages of RPA and TA.