Retroperitoneal Laparoscopic Nephrectomy Combined with Bench Surgery and Autotransplantation for Renal Cell Carcinoma in the Solitary Kidney or Tumor Involving Bilateral Kidneys: Experience at a Single Center and Technical Considerations.

OBJECTIVE: To assess the feasibility of retroperitoneal laparoscopic nephrectomy combined with bench surgery and autotransplantation in treating complex renal tumor.

PATIENTS AND METHODS: Six patients with complex renal tumor were seen in our institution between 2010 and 2014. Three patients with bilateral renal cell carcinoma underwent retroperitoneal laparoscopic nephrectomy on both sides. Extracorporeal tumorectomy and renal reconstruction were performed on the side of the smaller tumor and then kidney autotransplantation was performed. The other 3 patients with tumor involving the solitary kidney underwent laparoscopic nephrectomy combined with bench surgery and autotransplantation.

RESULT: The total time of the operation was 287 ± 25 min; warm ischemia time 3.1 ± 0.7 min; cold ischemia time 47 ± 8.1 min; and kidney autotransplantation required time 86 ± 8.6 min. Estimated blood loss was 232 ± 45.8 ml. Serum creatinine levels were 179 ± 44.7 µmol/l upon hospital discharge. Two patients received temporary hemodialysis. No patient needed further hemodialysis during follow-up. One patient died of multiple metastases 18 months after surgery. The other 5 patients survived without recurrence or metastasis during follow-up.

CONCLUSIONS: Retroperitoneal laparoscopic radical nephrectomy combined with bench surgery and autotransplantation is a feasible choice for patients with complex renal cell carcinoma in bilateral kidneys and tumor involving the solitary kidney.