Objective: Retroperitoneoscopy, by avoiding peritoneal breach and injury to intra-abdominal organs, provides a more direct and rapid access to the kidney and the renal hilum. Laparoscopic partial nephrectomy by retroperitoneal route (LPNR) is less commonly performed than transperitoneal route for early stage renal cancer. The objective of this study is to carry out the outcomes of partial nephrectomy using retroperitoneal approach. Materials and Methods: Patients, who underwent LPNR from period 2008 to 2014, were retrospectively analyzed. Outcomes of interest included demographic data, preoperative data, perioperative variables, surgical complications, recurrence of disease, and mortality, if any, during their follow-up. Results: Among 24 patients, 16 were male, and 8 were female. Mean age and mean body mass index, respectively, were 49.16 years (range: 25–75) and 25.35 kg/m2 (17.84–34.25). Among renal masses, the right-sided to left-sided distribution was 13:11. The proportions of low-risk and intermediate-risk nephrometry score (NS) cases were 13 (54.17%) and 11 (45.83%), respectively, as assessed by renal NS. Mean operative duration, mean warm ischemia time, mean estimated blood loss, and mean hospital stay, respectively, were 132.5 min (90–170), 21.83 min (15–44), 106 ml (25–300) ml, and 5.25 days. During the postoperative period, complications encountered were lung atelectasis in one, bleeding in two, and urinary leakage in one. Histopathology revealed malignancy in 23 patients and leiomyoma in the remaining one. All patients but two experienced a disease free survival during a median follow- up period of 33 months. Conclusion: Overall outcomes for LPNR is comparable to the outcomes for open and transperitoneal laparoscopic partial nephrectomy mentioned in the literature and is equally safe for the right-sided and left-sided lesions.

Introduction During vascular anastomosis the kidney graft slowly gain temperature and becomes warm. Regional hypothermia is shown to be effective to reduce rewarming of the kidney during robotic assisted laparoscopic kidney transplantation (RKT). Currently there is no study available to compare impact of regional hypothermia versus no hypothermia during RKT. Here we present data of RKT with and without regional hypothermia. Material and methods RKT was carried out in 100 patients; the first 50 cases had regional hypothermia and later 50 cases did not have hypothermia. Regional hypothermia was created by introducing 250-300 ml of ice slush around the kidney before carrying out vascular anastomosis. Body surface warming was carried out in all cases of regional hypothermia. Living donor kidney with single renal artery and vein was used in all cases. Results No case was converted to open operation. Longer anastomosis time and operative time in initial 50 cases represents learning curve of RKT.No delayed graft function was observed in any case and graft function was measured in terms of serum creatinine. (Figure-1). At 3 years there was no difference in graft and patient survival in either group (Figure-2a and 2b). Three patients in regional hypothermia group developed severe systemic hypothermia (temp. 94 degree F) and needed extubation in intensive care unit 6-12 hours after completion of surgery. Conclusion Regional hypothermia using ice slush may be useful during learning of RKT; however, once anastomosis time is reduced to less than 40 minutes, outcome of RKT without reginal hypothermia are similar to RKT with regional hypothermia. Severe systemic hypothermia may occur and intra-operative warming is required in patients subjected to regional hypothermia.