Laparoscopic resection of the kidney using transmesenterial access - first impression

For a quarter of the century since Ralph Clayman performed the first laparoscopic nephrectomy, technique of the operation has developed and was standardized to details: from the placing of the patient on the operation table to the evacuation of the specimen. The algorithm of every standard laparoscopic operation on the upper urinary tract suggests wide mobilization of colon with the aim to access the retroperitoneum. This stage is almost always lasts more than one third of the operation time and coupled with certain risks of iatrogenic injuries. The latter situation enforced the specialists to find the alternative approaches. One of the possibilities on the left side is transmesenterial access via the “window” in the mesentery of the descendent colon. This access is widely accepted for laparoscopic pyeloplasty, but nor for the tumor surgery. In this article we present our experience with laparoscopic transmesenterial partial nephrectomy. The number of the procedures performed is far not enough to carry out relevant statistical analysis. Nevertheless, we consider that in selected patients this access has certain advantages before the standard way and could be accounted for as alternative approach for the adrenalectomy, nephrectomy and partial nephrectomy.