Laparoscopic partial nephrectomy can be performed either by transperitoneal or retroperitoneal approach, both with specific advantages and drawbacks in terms of working space and peri-operative outcomes. The choice for the surgical approach is determined by the experience of the surgeon, the renal pedicle and tumor location – anterior tumors with single renal artery being thought to be more suitable for transperitoneal approach, and posterior tumors with multiple renal arteries for retroperitoneal approach. We analyzed 40 patients with anterior renal tumors and multiple arteries, which were randomly assigned to transperitoneal or retroperitoneal approach. We observed that transperitoneal approach associates a longer time for pedicle dissection in comparison with retroperitoneal approach, but a shorter tumor excision and renorraphy times. In conclusion, we consider that the transperitoneal approach ensures improved ergonomy for performing the excision and reconstruction steps of the partial nephrectomy, which impact the warm ischaemia time, thus the choice for the surgical approach should be based mainly on tumor location.
 

Download Full Text - PDF