Hand‐assisted laparoscopic vs the open (flank incision) approach to radical nephrectomy

• Published in: BJU international Vol. 91; no. 4; pp. 341 - 344
• Main Authors: Busby, E., Das, S., Rao Tunuguntla, H.S.G., Evans, C.P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.03.2003; Blackwell
• Subjects: Age Factors; Biological and medical sciences; Body Weight; Carcinoma, Renal Cell - surgery; Female; flank nephrectomy; hand‐assisted laparoscopic radical nephrectomy; Humans; Kidney Neoplasms - surgery; laparoscopic surgery; Laparoscopy - methods; Length of Stay; Male; Medical sciences; Middle Aged; Nephrectomy - methods; PneumoSleeveTM; renal tumours; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Treatment Outcome; Kidney disease; Human; Endoscopic surgery; Urinary system disease; Pneumosleeve; renal tumours; laparoscopic surgery; Malignant tumor; Kidney; flank nephrectomy; Functional recovery; Treatment; Nephrectomy; Hand-assisted laparoscopic surgery; Laparotomy; hand-assisted laparoscopic radical nephrectomy; Comparative study
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-410X.2003.04089.x

OBJECTIVE To compare the outcome in contemporaneous groups of patients undergoing hand‐assisted laparoscopic radical nephrectomy (HALRN) or open (flank) radical nephrectomy (ORN), as many series worldwide have confirmed the feasibility and advantages of LRN in managing renal cell carcinoma (RCC). PATIENTS AND METHODS We retrospectively evaluated 44 patients who underwent radical nephrectomy for RCC from 1999 to 2001, 22 by HALRN and 22 by ORN, through an extraperitoneal 11th or 12th rib flank incision. Standard perioperative variables were assessed; a validated questionnaire was also sent to each patient after surgery, allowing them to report their overall satisfaction and the period needed for them to return to both routine and full activities. The outcomes of HALRN and ORN were compared using Wilcoxon rank‐sum analysis. RESULTS There was a statistically significant difference between HALRN and ORN in operative duration, length of hospital stay, total narcotic requirement, pain scores at 1 week and 1 month after surgery, and the time to resume routine and full activity, with all variables (except operative duration) lower in the HALRN group. There were no significant differences between the groups in pain at 1–3 days, estimated blood loss or overall satisfaction. CONCLUSION Compared with ORN, HALRN is associated with lower narcotic requirement, pain scores, a shorter hospital stay and earlier resumption of routine and full activities. However, several obstacles remain, including increased operative duration and the increased equipment costs.