The transperitoneal approach (TP) and the retroperitoneal approach (RP) are two common methods for performing nephrectomy or partial nephrectomy. However, both approaches face difficulties, such as trocar placement and limited working space (RP). TP is impaired in the case of dorsal tumors and dissection of the renal artery can be challenging due to the anatomic localization dorsally to the renal vein. A hybrid approach that combines both methods has been previously reported in a case series, but not evaluated systematically. This study proposes a modified hybrid approach, which we call the transabdominal lumbar approach (TALA), involving late robotic docking after elaborating the retroperitoneum using conventional laparoscopy. The study compares the last 20 consecutive patients who underwent RP and the last 20 patients who underwent TALA at our institution. The investigated variables include operative time and amount of blood loss, hospitalization duration, postoperative analgesia requirement, and postoperative complications. The study found no significant difference in operative time, blood loss, ischemia time, or hospital stay between the two groups. The TALA group had fewer complications regarding Clavien–Dindo category 3, but one complication of category 4. In Conclusion, TALA is a safe and promising approach that combines the advantages of RP and TP.
经腹膜途径（TP）与腹膜后途径（RP）是实施肾切除术或部分肾切除术的两种常用方法。然而，这两种方法均面临操作困难，例如套管针放置及工作空间受限（RP）。对于背侧肿瘤，TP方法存在局限，且由于肾动脉位于肾静脉背侧的解剖位置，其分离过程可能具有挑战性。既往病例系列报道中曾提出结合两种方法的混合途径，但尚未进行系统评估。本研究提出一种改良混合途径，称为经腹腰侧途径（TALA），该方法在传统腹腔镜技术充分建立腹膜后操作空间后，进行延迟机器人对接。研究比较了本机构连续接受RP手术的最后20例患者与接受TALA手术的最后20例患者。观察指标包括手术时间、失血量、住院时长、术后镇痛需求及术后并发症。研究发现两组在手术时间、失血量、缺血时间及住院时间方面均无显著差异。TALA组在Clavien-Dindo分级3级并发症方面较少，但出现1例4级并发症。综上所述，TALA是一种安全且具有前景的手术途径，融合了RP与TP的双重优势。
肿瘤(癌症)患者之家