Efficacy of early use of snake retractor in retroperitoneoscopic nephrectomy or nephroureterectomy

Background and Purpose: A snake retractor is generally used to create a better surgical field and space, but when to start using it is still controversial. In this study, we used a snake retractor starting in an early stage of the procedure to safely perform surgery and compared the results with a control group in which the procedure depended on operator discretion. Patients and Methods: Twelve patients were enrolled in this study and compared with a control group (n=12) in which no special technique was used. We used four ports in both right- and left sided cases and used a snake retractor when removing the flank pad to create a better surgical space and field. We compared two groups in operative time, intraoperative blood loss, and body mass index (BMI). Results: Three surgeons were enrolled. In the intervention group (early use of snake retractor), operative time was 107 to 300 minutes (median 162min), and intraoperative blood loss was 0 to 462g (69.5g). In the control group, operative time was 185 to 485 minutes (258min) and intraoperative blood loss was 0 to 302g (40g). Operative time was significantly shorter in the intervention group than the control group (P=0.0034). There was no significant correlation with intraoperative blood loss volume and BMI in these two groups. We did not have any patients with metastasis or recurrence of cancer in either group in post-operative follow-up. Only the control group included a case with a slight duodenum injury. Conclusions: Early use of the snake retractor in retroperitoneoscopic nephrectomy or nephroureterectomy may produce a significantly safer operative procedure.