Hand-assisted laparoscopic radical nephrectomy: comparison with transabdominal radical nephrectomy

Abstract

The purpose of this study was to investigate whether hand-assisted laparoscopic radical nephrectomy (HALN) has benefits over the traditional transabdominal radical nephrectomy. More specifically we focused on the use of the hand-assisted technique as a definitive oncologic procedure for renal cancers. This study is a retrospective nonrandomized study comparing 12 hand-assisted laparoscopic radical nephrectomies with 12 transabdominal radical nephrectomies. All patients included in the study had the preoperative diagnosis of renal mass. HALN population averaged 1.83 +/- 1.64 (mean +/- standard deviation) major comorbidities versus 1.08 +/- 0.8 open (P = 0.032). The HALN OR time averaged 103 +/- 32.8 versus 57 +/- 18.3 minutes open (P = 0.001). The estimated blood loss mean for HALN was 83 versus 318 cm3 open (P = 0.001). Length of stay for HALN was 4.9 +/- 2.2 versus 5.9 +/- 2.9 days (P = 0.35). Days to regular diet was 2.9 +/- 2.3 in HALN versus 3.5 +/- 2.11 open (P = 0.52). Days of intravenous pain medications were 1.8 +/- 0.72 HALN versus 3.0 +/- 1.28 open (P = 0.016). Postoperative complication rates for the two groups were identical: two of 12 (ileus and post-operative bleeding). Tumor size mean was 6.8 +/- 2.99 cm for HALN versus 4.2 +/- 1.29 cm open (P = 0.012). Tumor margins were negative for 12 of 12 in HALN versus 11 of 12 open. Selection bias (selecting ailing patients to the HALN cohort) diminished the statistical significance of our postoperative recovery data. It is likely that a prospectively randomized study with a larger population may prove the hand-assisted approach equal if not superior to the open technique. The use of HALN in patients with renal tumors is an effective alternative to traditional transabdominal radical nephrectomy.