-Case Reports-

Massive Hemorrhage during Retroperitoneal Laparoscopic Radical Nephrectomy: A Case Report

Masato Yanagi¹, Tsutomu Hamasaki², Jun Akatsuka¹, Yuki Endo¹, Hayato Takeda¹, Tatsuro Hayashi¹ and Yukihiro Kondo¹

¹Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
²Department of Urology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan

Laparoscopic radical nephrectomy (LRN) is the standard surgical treatment for localized renal cell carcinoma. LRN can be performed using a transperitoneal or retroperitoneal approach. We report a case of a complication specific to the retroperitoneal approach. A 63-year-old woman with localized right renal cell carcinoma was treated with retroperitoneal LRN. During placement of the first port, tumor vessels were damaged by a balloon dilator. Massive hemorrhage from the retroperitoneal cavity required conversion to retroperitoneal laparotomy to stop the bleeding. When laparotomy was performed, active bleeding had already ceased. The bleeding was caused by damage to the tumor vessels from the balloon dilator. Subsequent nephrectomy was performed without other complications. This case suggests that the transperitoneal approach is safer than the retroperitoneal approach when a tumor is located laterally and contains many tumor vessels.

J Nippon Med Sch 2021; 88: 367-369

Keywords
laparoscopic nephrectomy, balloon dilator, complication, tumor vessels, open conversion

Correspondence to
Masato Yanagi, Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
area-i@nms.ac.jp

Received, May 20, 2020
Accepted, September 11, 2020