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Minerva Urologica e Nefrologica 2018 August;70(4):414-21

DOI: 10.23736/S0393-2249.18.03075-8


language: English

Entry techniques in laparoscopic radical and partial nephrectomy: a multicenter international survey of contemporary practices

Pierluigi BOVE 1, Valerio IACOVELLI 1 , Marco SANDRI 2, Marco CARILLI 1, Luca CINDOLO 3, Riccardo AUTORINO 4, Louis R. KAVOUSSI 5, Salvatore MICALI 6, Francesco PORPIGLIA 7, Koon H. RHA 8, Fernando J. KIM 9, on behalf of AGILE Group and Uro-Laparoscopic Group 

1 Department of Experimental Medicine and Surgery, Urology, Tor Vergata University of Rome, Rome, Italy; 2 DMS StatLab, Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy; 3 Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Chieti, Italy; 4 Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA; 5 Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York, NY, USA; 6 Department of Urology, University of Modena & Reggio Emilia, Modena, Italy; 7 Division of Urology, Department of Oncology, University of Turin San Luigi Hospital, Orbassano, Italy; 8 Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea; 9 Department of Urology, Denver Health Medical Center, Denver, CO, USA

BACKGROUND: There is no clear consensus as to the optimal method of entry in laparoscopic renal surgery and no reports have compared them in Urology. To analyze contemporary practice patterns in entry technique and port placement for laparoscopic kidney surgery.
METHODS: We identified 60 high volume urological laparoscopic centers. A purpose-built questionnaire was sent to surgeons. The survey included 22 questions regarding access techniques and port configuration during laparoscopic kidney surgery. Data on were collected and retrospectively analyzed. Concordance among port configurations was assessed using Cohen’s Kappa statistics.
RESULTS: The survey was sent to 60 surgeons and completed by 32 of them. Surgical procedures included were laparoscopic radical nephrectomy (1177 LRN/year) and laparoscopic partial nephrectomy (1047 LPN/year). The transperitoneal route was preferred (85%). Hasson technique was used for the access in 55% of the cases. Patient lateral recumbent position is the most frequently used during the port placement (41%). Although there is a high variability in the port positioning among the surgeons, in more than 90% of cases it was found a specific concordance in triangulation of optics and operating trocars. There were no significant differences between port configuration in LRN and LPN. Limitations include retrospective design and limited sample.
CONCLUSIONS: A standard port configuration has not been previously reported in urological literature. Our study suggests that the transperitoneal approach, the Hasson technique and a specific triangulation of optics and operating trocars have a significant concordance in some high volume laparoscopic urologic centers.

KEY WORDS: Laparoscopy - Urology - Nephrectomy

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