Left Laparoscopic Radical Nephrectomy with Direct Access to the Renal Artery: Technical Advantages

Objectives: To evaluate the technical advantages of early ligature of the renal artery at the level of the Treitz ligament during left laparoscopic radical nephrectomy (LRN). Material and methods: Twenty-six patients underwent LRN for organ-confined lesions. We grouped measured parameters (see Results) on the basis of the first 13 and last 13 patients, and compared both subgroups. All parameters were correlated to stage of disease (pT1 vs pT2-3). The Student t test was used for statistical analysis. Results: The mean (range) for measured parameters are as follows: age: 56.5 ± 11.6 (41-77) years; American Society of Anesthesiologists score: 2.4 ± 1 (1-3); body mass index: 23.4 ± 3.4 (21.1-33); lesion size at computed tomography: (6.2 ± 2.4 (4-12) cm; operative skin to skin time: 130 ± 20 (125-170) minutes; blood loss: 255 ± 120 (100-800) ml; hospital stay: 6.5 ± 2.0 (4-15) days; analgesic consumption (Tramadol 100 mg): 2.5 ± 1 (2-4) vials; follow-up time: 30.5 ± 5.6 (3-48) months. No intra-operative complications occurred. Pathologic analysis showed 12 pT1N0, five pT2N0, eight pT3aN0 and one pT3b N2 with mean lesion size of 6.2 ± 1.6 (4-13) cm. Mean number of removed lymph nodes was 9.8 ± 1.6 (7-17). No statistical difference was observed between the two subgroups (p > 0.05), and between pT1 and pT2-3 stage (p > 0.05) groups. Conclusions: Early ligature using direct access to the renal artery at the Treitz ligament permits the surgeon to follow the classic steps and principles of radical nephrectomy.