Anatomie et physiologie : recherches en cours
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A Study of Fascia and Space Anatomy Layers about Adrenal Gland-Sparing in Retroperitoneal Laparoscopic Radical Nephrectomy

Wang Q, Guangzhen W, Quanlin L, Xiangyu C, Jiang T, Zheng L and Tang Q

Objective: The objective of this study was to study fascia and space anatomy layers in retro peritoneum, in order to find a modified method in bloodless and the anatomical retroperitoneal laparoscopic radical nephrectomy, and improve operation skills about adrenal gland-sparing.

Methods: From march 2016 to march 2017, a total of 61 patients with localized renal cell carcinoma were analysed, 38 tumors were located in left kidney, and 23 in the right kidney, the diameter of renal tumor was 3.4-7.5 cm, with the mean diameter was 5.6 cm, we complement bloodless and the anatomical operation by exposing and separating relatively bloodless planes such as anterior pararenal space, pre-psoas space, the space between anterior lamella and prerenal fusion fascia, and all patients underwent adrenal gland-sparing surgery based on the theory of fascia and space anatomy layers.

Results: All 61 operations were successfully operated, with no case transferred to open operation. The mean operative time was 66 min(range from 45 to 99 min), and the mean intraoperative blood loss was 80 ml (range from 25 to 160 ml), all patients discharged from hospital on 4 to 7 days after surgery, the mean postoperative hospital stay was 5 days. Adrenal gland laceration and slight bleeding were 5 cases, no case had blood transfusion and other severe complications during surgery.

Conclusions: On the basis of fascia and space anatomy layers in retroperitoneum, through identifying and separating relatively bloodless planes such as anterior pararenal space, pre-psoas space, the space between anterior lamella and prerenal fusion, we can expose the operation space, renal and adjacent organs can be discrimination directly, and adrenal gland-sparing is easier to perform, so we can complement operation bloodlessly and anatomically. This method is a safe and effective procedure, it can decrease operation time, blood loss and complication rates effectively.