Korean J Urol.  2006 Jan;47(1):64-69. 10.4111/kju.2006.47.1.64.

Comparison of Hand-assisted versus Transperitoneal Laparoscopic Simple Nephrectomy

• Kang IS
• Seo IY
• Jeong HJ

• KMID: 2294217
• DOI: http://doi.org/10.4111/kju.2006.47.1.64

Abstract

PURPOSE: We compared the results of our experience with hand-assisted laparoscopic simple nephrectomy (HALN) and the standard laparoscopic simple nephrectomy with the transperitoneal approach for treating benign renal diseases.
MATERIALS AND METHODS
Between March 2002 and March 2004, 38 patients, including 36 patients with a non-functioning kidney and 2 angiomyolipomas, received laparoscopic simple nephrectomies. The HALN approach method was used for 11 patients and transperitoneal standard laparoscopy was used for 27 patients. The operative and clinical records were retrospectively reviewed.
RESULTS
The mean patient age and gender were not significantly different in the HALS and standard groups. The procedures were performed successfully in all but 2 patients. Intraoperatively, one patient of HALN group had spleen injury, which was treated with splenectomy. One patient of the standard group had open conversion due to dissection difficulty because of severe adhesions. Postoperatively, one patient of the standard group had intraperitoneal hematoma, which was treated conservatively. The mean operative time, initiation of the postoperative oral intake and the initiation day for ambulation were not significantly different in both groups. The analgesic use (diclofenac sodium, 90.0mg versus 22.5mg, respectively) and the postoperative hospital stay (7.2 days versus 5.6 days, respectively) was shorter in the standard group than in the HALN group (p<0.05).
CONCLUSIONS
Standard laparoscopic simple nephrectomy with the transperitoneal approach is a less invasive technique than hand-assisted nephrectomy. There is no difference in the technical difficulty according to the operative time and complication rate.

Keyword

Laparoscopy; Hand; Nephrectomy

MeSH Terms

Angiomyolipoma
Hand
Hematoma
Humans
Kidney
Laparoscopy
Length of Stay
Nephrectomy*
Operative Time
Retrospective Studies
Sodium
Spleen
Splenectomy
Walking
Sodium

Figure

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  Fig. 1 Port sites and incision location for right (A) and left (B) hand-assisted laparoscopic simple nephrectomy. MCL: mid-clavicular line, AAL: anterior axillary line, PAL: posterior axillary line.

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  Fig. 2 Port sites and incision location for right (A) and left (B) hand-assisted laparoscopic simple nephrectomy. MCL: mid-clavicular line, AAL: anterior axillary line, PAL: posterior axillary line.

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  Fig. 3 Operating time of hand-assisted laparoscopic simple nephrectomy.

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  Fig. 4 Operating time of standard laparoscopic simple nephrectomy.

Reference

1. Kim HH. Laparoscopic surgery in urology (I). Korean J Urol. 2003. 44:945–958.

2. Nelson CP, Wolf JS Jr. Comparison of hand assisted versus standard laparoscopic radical nephrectomy for suspected renal cell carcimona. J Urol. 2002. 167:1989–1994.

3. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991. 146:278–282.

4. Wolf JS Jr, Moon TD, Nakada SY. Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy. J Urol. 1998. 160:22–27.

5. Doublet JD, Barreto HS, Lukacs B, Cattegno B, Thibault P. Renal: retroperitoneal nephrectomy: comparison of laparoscopy and open surgery. Br J Surg. 1995. 82:127.

6. Higashihara E, Baba S, Nakagawa K, Murai M, Go H, Takeda M, et al. Learning curve and conversion to open surgery in cases of laparoscopic adrenalectomy and nephrectomy. J Urol. 1998. 159:650–653.

7. Guazzoni G, Montorsi F, Bocciardi A, Da Pozzo L, Rigatti P, Lanzi R, et al. Transperitoneal laparoscopic versus open adrenalectomy for benign hyerfunctioning adrenal tumors: a comparative study. J Urol. 1995. 153:1597–1600.

8. Vargas HI, Kavoussi LR, Bartlett DL, Wagner JR, Venzon DJ, Fraker DL, et al. Laparoscopic adrenalectomy: a new standard of care. Urology. 1997. 49:673–678.

9. Batler RA, Campbell SC, Funk JT, Gonzalez CM, Nadler RB. Hand-assisted vs. retroperitoneal laparoscopic nephrectomy. J Endoruol. 2001. 15:899–902.

10. Hayakawa K, Aoyagi T, Ohashi M, Hata M. Comparison of Gas-less laparoscopy-assisted surgery, hand-assisted laparoscopic surgery and pure laparoscopic surgery of radical nephrectomy. Int J Urol. 2004. 11:142–147.

11. Capelouto CC, Kavoussi LR. Complications of laparoscopic surgery. Urology. 1993. 42:2–12.

12. Gill IS, Kavoussi LR, Clayman RV, Ehrlich R, Evans R, Fuchs G, et al. Complications of laparoscopic nephrectomy in 185 patients: a multi-institutional review. J Urol. 1995. 154:479–483.

13. Rassweiler JJ, Seemann O, Frede T, Henkel TO, Alken P. Retroperitoneoscopy: experience with 200 cases. J Urol. 1998. 160:1265–1269.

14. Hemal AK, Gupta NP, Kumar R. Comparison of retroperitoneoscopic nephrectomy with open surgery for tuberculous nonfunctioning kidneys. J Urol. 2000. 164:32–35.

15. Gupta NP, Agrawal AK, Sood S. Tubercular pyelonephritic nonfunctioning kidney-another relative contraindication for laparoscopic nephrectomy: a case report. J Laparoendosc Adv Surg Tech A. 1997. 7:131–134.

16. Kim HH, Kang J, Kwak C, Byun SS, Oh SJ, Choi H. Laparoscopy for definite localization and simultaneous treatment of ectopic ureter draining a dysplastic kidney in children. J Endourol. 2002. 16:363–366.