To optimize the surgical procedures and outcomes of retroperitoneal laparoscopic radical nephrectomy.

The clinical data of 143 patients who underwent retroperitoneal laparoscopic nephrectomy from September 2013 to September 2016 were retrospectively analyzed. The control group (n=65) were performed with routine technique, and the research group (n=78) underwent expanded dissection of prepsoas space. The criteria of dissection range as follow: the upper bound to the diaphragmatic dome, the lower bound to the bottom of Gerota's fascia, and incising the anterior renal fascia until exposing the loose reticular tissue. The mean surgical time, mean blood loss, complication incidence and postoperative hospital stay were compared between the groups.

There were no differences in gender, age, tumor size, and TNM stage between the two groups (P<0.05). The differences were significant for mean surgical time (95.1±15.1 vs 53.6±20.3) minutes, mean intraoperative blood loss (80.6±25.6 vs 45.1±19.7) ml, between the control group and research group (P>0.05). The differences were not significant in complication incidence (6.2% vs 1.3%), postoperative intestine exhaust time (2.1±0.4 vs 2.0± 0.4) d, duration of hospital stay (6.2±1.8 vs 5.7±1.5) d between the control group and research group (P>0.05). In the control group, 4 cases were found extensive surgical bleeding after ligation of renal blood vessels, due to unknown ectopic artery existing. Among them, 1 case of ectopic artery was quickly isolated and disposed, and then the surgery was completed, the other 3 cases were turned to open surgery. One case was found pneumothorax in research group, who was cured upon thoracic drainage in 3 days.

The technique of expanded dissection of prepsoas space in retroperitoneal laparoscopic nephrectomy is the optimization of conventional surgical procedure, which contributes to shorten surgical time and reduce perioperative complications compared with the previous.