Transperitoneal laparoscopic radical nephrectomy is an effective procedure for large (more than 7 cm) renal masses

Purpose: We aimed to evaluate our experience with the transperitoneal radical nephrectomy (TLRN) in patients with large (morethan 7 cm) renal mass to determine if this procedure can be recommended as a reference standard for treating large renalmasses. Patients and Methods: Of 213 patients who underwent TLRN in both institutions we have reviewed medical files of 35 who had large than 7 cm renal masses. Operative time, blood loss, conversion rate, pathologic tumor type, and oncologic outcome were evaluated. Results: The mean tumor size was 10.1 cm (range: 7 to 19 cm).Mean blood loss during surgery was 388mL (range: 150 to 600 mL). In 2 patients with 16 cm renal masses the operation was converted to hand-assisted technique as planned upon the surgery after ligation and transsection of the vascular pedicel to facilitate kidney dissection from surrounding tissue. In 1 patient the operation was converted to the open technique. Twenty-two (62.8%) patients had renal cell carcinoma and the remaining13(37.5%) patients had other types of the renal tumors. Mean hospital stay was 4.36 days (range: 3 to 7 d). Median follow-up after the surgery was 29 months (range: 8 to 60 mo). Three patients who underwent cytoreduction nephrectomy died whereas receiving immunotherapy 3, 8, and 11 months, respectively, after surgery. One patient developed a local tumor recurrence and 2 developed remote metastasizes. Conclusions: Our data show that TLRN is an effective procedure for the removal larger than 7 cm renal tumors. In those patients with exceptionally big tumors planned conversion to the handassisted technique after laparoscopic ligation of the renal vessels enabling easier renal dissection whereas preserving the advantagesof minimally invasive procedure.