Hand-Assisted Laparoscopic Nephrectomy

Abstract

Purpose: We report our experience in performing a hand-assisted laparoscopic radical nephrectomy (HALRN) for renal cell carcinoma (RCC) and a hand-assisted laparoscopic live donor nephrectomy (HALDN) for renal transplantation. Patients and Methods: The clinical data on 21 patients with HALRN for stage T1N0M0 RCC and 5 living kidney donors with HALDN for renal transplantation were reviewed. We compared the results of 21 HALRNs with those of 15 conventional open radical nephrectomies for stage T1N0M0 RCC. Results: The HALRN for RCC was successfully performed without any major complications in all 21 patients. The mean operation time for the HALRN group was significantly longer than that for the open surgery group (262 minutes versus 219 minutes). However, the mean estimated blood loss in the HALRN group was less than that in the open surgery group (250 ml versus 388 ml), although there was no statistically significant difference. The frequency in usage of analgesia postoperatively in the HALRN group was significantly less than that in the open surgery group (2.5 times versus 7.3 times). The HALDN was also successfully performed without any major complications in all 5 cases. The mean operation time, blood loss and warm ischemic time were 248 minutes, 322 ml and 9.8 minutes, respectively. All donors resumed oral intake of food within 48 hours after the surgery and returned to normal, non-strenuous activity by postoperative day 8. Conclusions: Our results indicate that a hand-assisted laparoscopic nephrectomy is an effective and safe surgical procedure, and it is less invasive than an open nephrectomy.

Key words

Hand assistance - laparoscopic nephrectomy - renal cell carcinoma - renal transplantation - living kidney donor

References

• 1 McDougall E M, Clayman R V, Elashry O. Laparoscopic radical nephrectomy for renal tumor: the Washington University experience.  J Urol. 1996;  155 1180-1185
• 2 Ono Y, Katoh N, Kinukawa T, Matsuura O, Ohshima S. Laparoscopic radical nephrectomy: the Nagoya experience.  J Urol. 1997;  158 719-723
• 3 Ratner L E, Ciseck L J, Moore R G, Cigarroa F G, Kaufman H S, Kavoussi L R. Laparoscopic live donor nephrectomy.  Transplantation. 1995;  60 1047-1049
• 4 Nogueira J M, Cangro C B, Fink J C, Schweitzer E, Wiland A, Klassen D K, Gardner J, Flowers J, Jacobs S, Cho E, Philosophe B, Bartlett S T, Weir M R. A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy.  Transplantation. 1999;  67 722-728
• 5 Tanaka M, Tokuda N, Koga H, Yokomizo A, Sakamoto N, Naito S. Hand-assisted laparoscopic radical nephrectomy for renal carcinoma using new abdominal wall sealing device.  J Urol. 2000;  164 314-318
• 6 Tokuda N, Nakamura M, Tanaka M, Naito S. Hand-assisted laparoscopic live donor nephrectomy using newly produced LAP DISC: initial three cases.  J Endourol. 2001;  15 571-574
• 7 Wolf Jr J S, Moon I D, Nakada S Y. Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy.  J Urol. 1998;  160 22-27