Korean J Urol.  2006 Oct;47(10):1046-1051. 10.4111/kju.2006.47.10.1046.

Laparoscopic Radical Nephrectomy for Renal Tumor: Comparison with Hand-assisted and Open Radical Nephrectomy

• Park YH
• Jeong BC
• Kim HH

• KMID: 2139803
• DOI: http://doi.org/10.4111/kju.2006.47.10.1046

Abstract

PURPOSE: We wanted to evaluate the safety and efficacy of standard laparoscopic radical nephrectomy (LRN) as compared to hand-assisted laparoscopic radical nephrectomy (HALS) and open radical nephrectomy (ORN) when the three different procedures were all performed by a single experienced surgeon.
MATERIALS AND METHODS
Between May 2000 and September 2005, 62 consecutive patients with renal tumor underwent LRN (16 patients), HALS (18 patients), or ORN (32 patients) by a single surgeon who had performed more than 100 laparoscopic surgeries. The surgical results such as the operation time, estimated blood loss (EBL), transfusion rate, narcotic analgesia requirement, hospital stay and complications, and pathologic results were reviewed retrospectively.
RESULTS
The LRNs and HALSs were successfully performed for all patients without open conversion. The final pathologic reports showed renal cell carcinomas in 65 cases and oncocytoma in 1 case. There were no significant differences of demographic data between the three groups. For the LRN, HALS, and ORN patients, the mean tumor size was 2.8cm (1.3-8.5), 4.5cm (1.5-13.5) and 5.6cm (1.0-12.5), respectively, the mean weight of the removed kidney was 200.6g (63-375), 214.5g (122-444.3) and 367.0g (122-823), respectively, the mean operation time was 174.8 min. (125-232), 196.4 min. (150-350) and 157.7 min. (110-265), respectively, the EBL was 140ml (50- 400), 108ml (50-600) and 297ml (50-700), respectively, the transfusion rate was 0%, 5.6% and 15.6%, respectively, the narcotic analgesia requirement was 20mg, 15mg and 43mg of morphine sulfate, respectively, the postoperative hospital stay was 4.8 days, 5.2 days and 10.5 days respectively, and the number of complication was 1/16 cases (6.3%), 1/18 cases (5.6%) and 4/32 cases (12.5%) respectively. The surgical and pathological parameters of LRN showed no significant difference compared to those of the HALS.
CONCLUSIONS
LRN for renal tumors was less invasive than ORN and it showed similar surgical results to HALS. Therefore standard laparoscopic radical nephrectomy is considered to be an effective and safe treatment modality for renal tumors.

Keyword

Laparoscopic surgery; Nephrectomy; Carcinoma; renal cell

MeSH Terms

Adenoma, Oxyphilic
Analgesia
Carcinoma, Renal Cell
Humans
Kidney
Laparoscopy
Length of Stay
Morphine
Nephrectomy*
Retrospective Studies
Morphine

Figure

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  Fig. 1. Trocar placement for standard and hand-assisted laparoscopic radical nephrectomy.

Reference

1.Clayman RV., Kavoussi LR., Soper NJ., Dierks SM., Meretyk S., Darcy MD, et al. Laparoscopic nephrectomy: initial case report J Urol. 1991. 146:278–82.

2.Nakada SY., Moon TD., Gist M., Mahvi D. Use of pneumo sleeve as an adjunct in laparoscopic nephrectomy. Urology. 1997. 49:612–3.

3.Wolf JS Jr., Moon TD., Nakada SY. Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy. J Urol. 1998. 160:22–7.

4.Steinberg AP., Finelli A., Desai MM., Abreu SC., Remani AP., Spaliviero M, et al. Laparoscopic radical nephrectomy for large (greater than 7cm, T2) renal tumors. J Urol. 2004. 172:2172–6.

5.Makhoul B., De La Taille A., Vordos D., Salomon L., Sebe P., Audet JF, et al. Laparoscopic radical nephrectomy for T1 cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy. BJU Int. 2004. 93:67–70.

6.Gill IS., Matin SF., Desai MM., Kaouk JH., Steinberg A., Mascha E, et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol. 2003. 170:64–8.

7.Ramani AP., Desai MM., Steinberg AP., Ng CS., Abreu SC., Kaouk JH, et al. Complications of laparoscopic partial nephrectomy in 200 cases. J Urol. 2005. 173:42–7.

8.Landman J., Lento P., Hassen W., Unger P., Warerhouse R. Feasibility of pathological evaluation of morcellated kidneys after radical nephrectomy. J Urol. 2000. 164:2086–9.

9.Hernandez F., Rha KH., Pinto PA., Kim FJ., KUcos N., Chan TY, et al. Laparoscopic nephrectomy: assessment of morcellation versus intact specimen extraction on postoperative status. J Urol. 2003. 170:412–5.

10.Ono Y., Kinukawa T., Hatton R., Gotoh M., Kamihira 0., Ohshima S. The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol. 2001. 165:1867–70.

11.Gettman MT., Napper C., Corwin TS., Cadeddu JA. Laparoscopic radical nephrectomy: prospective assessment of impact of intact versus fragmented specimen removal on postoperative quality of life. J Endourol. 2002. 16:23–6.

12.Fenrie DD., Barrett PH., Taranger LA. Metastatic renal cell cancer after laparoscopic radical nephrectomy: long term follow-up. J Endourol. 2000. 14:407–11.

13.Desai MM., Strzempkowski B., Martin SF., Steinberg AP., Ng C' Meraney AM, et al. Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy. J Urol. 2005. 173:38–41.

14.McDougall EM., Clayman RV., Elashry OM. Laparoscopic radical nephrectomy for renal tumor: the Washington University experience. J Urol. 1996. 155:1180–5.

15.Nelson CP., Wolf JS Jr. Comparison of hand assisted versus standard hparoscopic radical nephrectomy suspected renal cell carcinoma. J Urol. 2002. 167:1989–94.

16.Okeke AA., Timoney AG., Keeley FX. Hand-assisted laparoscopic nephrectomy: complications related to the hand-port site. BJU Int. 2002. 90:364–7.

17.Paick SH., Kim HH., Lee SE. Initial experience of hand assisted laparoscopic radical nephrectomy for renal cell carcinoma. Korean J Urol. 2001. 42:465–70.