Three-trocar partial nephrectomy for the treatment of renal cell carcinoma compared with the standard four-trocar technique: a prospective cohort study

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Introduction. Since the first report of laparoscopic nephrectomy by R.V. Clayman in 1991, laparoscopic techniques have become widespread in renal procedures. H.N. Winfield et al. performed the first transperitoneal partial nephrectomy in 1993, while I. Gill et al. described the first retroperitoneal partial nephrectomy one year later. All of the above techniques involved the use of four or more trocars. The fourth (additional) trocar is put for the assistant. There is an opinion that in most cases it is possible to perform partial nephrectomy without an assistant trocar, while maintaining the safety and efficiency of the procedure.

Aim. To compare the safety and efficiency of three-trocar and four-trocar partial nephrectomy.

Materials and methods. Between 2021 and 2023, a total of 200 patients were randomized to three- or four-trocar partial nephrectomy.

Results. There was no difference in the rate of achieving renal trifecta between the two groups. In the three-trocar group, 94 cases of renal trifecta were found, while in the four-trocar group, there were 95 patients with renal trifecta.

Conclusions. The three-trocar technique is not inferior in safety and efficiency to the standard four-trocar technique. The main advantages of the three-trocar technique are less pain, cost and post-operative scarring.

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作者简介

А. Kurbanov

Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University

编辑信件的主要联系方式.
Email: asadulla10@mail.ru

Ph.D. student

俄罗斯联邦, Moscow

S. Kryukov

Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University

Email: s.krukov78@gmail.com

6-year student

俄罗斯联邦, Moscow

Ya. Chernov

Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University

Email: chinenovdv@rambler.ru

Ph.D., urologist

俄罗斯联邦, Moscow

D. Chinenov

Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University

Email: chinenovdv@rambler.ru

Ph.D., associate professor 

俄罗斯联邦, Moscow

E. Shpot

Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University

Email: shpot@inbox.ru

Ph.D., MD, professor 

俄罗斯联邦, Moscow

参考

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2. Figure. Trocar placement for three- and four-port approaches 1A. 3 trocars on the left anterior abdominal wall 1B. 3 trocars on the left anterior abdominal wall 1C. 4 trocars on the left anterior abdominal wall. 4th trocar for the assistant’s work (work of the aspiration-irrigation system, kidney retraction) 1D. 4 trocars on the anterior abdominal wall on the right. 4th trocar for liver retraction

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