Assessment of umbrella-shaped layout for trocar puncture in pure laparoscopic partial nephrectomy with retroperitoneal approach

Abstract Background Laparoscopic partial nephrectomy (LPN) is one of the main methods for treating renal cancer. There are many types of puncture hole layouts, and umbrella layouts are less commonly used. This study aimed to investigate the efficacy and safety of retroperitoneal LPN with an umbrella-shaped layout for localized renal cell carcinoma. Methods Eighty patients with stage T1a renal cancer who were admitted to our hospital from May 2017 to March 2021 and underwent retroperitoneal LPN were selected. Patients were divided into two groups according to the position of the puncture hole: Trapezoidal layout group and umbrella-shaped layout group. Demographic and clinical data were retrospectively analyzed. Results The warm ischemia times, operative times, and amount of blood loss for the trapezoidal and umbrella-shaped layout groups were 19.8 min and 15.8 min, 96.9 min and 85.0 min, and 86.2 ml and 73.5 ml, respectively; the differences were statistically significant ( P < 0.05). The postoperative complication rates of the trapezoidal and umbrella-shaped layout groups were 20% (8/40) and 17.5% (7/40), respectively. The postoperative hospitalization periods of the trapezoidal and umbrella-shaped layout groups were 9.1 days and 8.9 days, respectively. At 6 months after surgery, the glomerular filtration rates (GFR) of the affected side of the trapezoidal and umbrella-shaped layout groups were decreased by 10.3 ml/min·1.73 m 2 and 9.6 ml/min·1.73 m 2 ; the differences were not statistically significant ( P > 0.05). All pathological margins were negative. During postoperative follow-up, there was one case of recurrence in the trapezoidal layout group and no recurrence in the umbrella-shaped layout group. Conclusion The umbrella-shaped layout is safe and effective for retroperitoneal LPN and superior to the trapezoidal layout in terms of operative time, warm ischemia time, and blood loss.