Hand-assisted laparoscopic radical nephrectomy

Laparoscopic radical nephrectomy is the standard of care for the management of most renal cancers. The hand-assisted approach has bridged the gap between open nephrectomy and a pure laparoscopic approach. Hand-assisted laparoscopic nephrectomy allows tactile feedback, thus shortening the learning curve for some surgeons and allowing more experienced laparoscopists to perform more complex and challenging procedures.     

Hand-assisted laparoscopic radical nephrectomy

Laparoscopic radical nephrectomy is the new standard of care for localized renal cancer. Hand assistance makes the procedure less daunting by providing tactile feedback. The authors consider the indications, contraindications, and technique for this operation, which provides the patient with the benefits of minimally invasive surgery while shortening the learning curve for the surgeon and allowing experienced laparoscopists to carry out more complex and challenging operations.     

Hand-assisted laparoscopic radical nephrectomy in pregnancy

Purpose

To demonstrate the beneficial results of hand-assisted laparoscopic tumor nephrectomy in pregnancy and to emphasize the proper timing of such surgery for its crucial importance attempting to avoid fatal cancer-related outcomes as a result of late interventions of aggressive tumors.

Methods

A report of a 32-year-old woman with a 61 × 41 mm chromophobe renal cell carcinoma (RCC) successfully treated with laparoscopic transperitoneal hand-assisted nephrectomy during the 20th week of gestation is presented.

Results

The fetus was stable during the intervention; the postoperative period was uneventful; she had a normal vaginal delivery at term and gave birth to a healthy female child. The patient remained tumor-free at her 34-month follow-up.

Conclusion

Although the pure laparoscopic interventions have become recognized in the treatment of RCC over the last decade, these methods have their limitations and dangers as well. The hand-assistance method makes the procedure faster and safer which is especially important during second or third trimester. Renal biopsy may play a specifically important role in predicting the malignant potential of a renal tumor, whereas postponement of this surgery until after delivery, may lead to the mother’s death. To our knowledge, this is the first report on hand-assisted laparoscopic nephrectomy in pregnancy.     

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

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.     

Hand-assisted laparoscopic radical nephrectomy: comparison with conventional open radical nephrectomy

PURPOSE: To compare the outcomes of hand-assisted laparoscopic radical nephrectomy (HALRN) with those of open radical nephrectomy (ORN) for renal-cell carcinoma (RCC). PATIENTS AND METHODS: A total of 130 patients with stage T(1) or T(2) RCC with a maximum diameter < 10 cm underwent radical nephrectomy by HALRN (n = 63) or ORN (n = 67). Data from these two groups were reviewed retrospectively. RESULTS: Although the maximum tumor size treated by HALRN was significantly less than that treated by ORN, there were no significant differences in the remaining features of the two groups. One HALRN was converted to open surgery. The mean operative time for HALRN (273 minutes) was significantly longer than that for ORN (189 minutes), whereas the mean estimated blood loss (315 v 381 mL). There were significant differences in measures of postoperative recovery, including time to walking (1.4 days for HALRN v 2.2 days for ORN), time to oral intake (1.8 v 3.3 days), and time to grant of permission for hospital discharge (7.4 v 10.2 days). Postoperative complications were observed in one and four patients in the HALRN and ORN groups, respectively. There were no significant differences in the recurrence-free and cancer-specific survival rates in the two groups. CONCLUSIONS: Despite the longer operative time, HALRN represents an effective, safe, and less-invasive treatment option for RCC. If performed for the proper indications, HALRN could achieve cancer control similar to that available with ORN.     

Hand-assisted laparoscopic nephrectomy

Introduction and objectivesTo present the number of cases of hand-assisted laparoscopic nephrectomy. This study evaluates our results and difficulties of starting a progresive programme of laparoscopy.Material and MethodBetween november 2003 and november 2005, 35 hand-assisted laparoscopic nephrectomies were carried out, of a total of 45 laparoscopic nephrectomies. 22 radical nephrectomies, 3 simple nephrectomies and 10 nephroureterectomies. The average age of patients was 66 years (47-89). On average, they were overweight (IMC 28,3), with approximately 38% being obese. ASA 2.3 (1-4). The tumors measured 4.8cm on average, and 80% of these were T1. In 28.6% of the cases, they had previously undergone abdominal surgery.ResultsOne was undertaken in 2003, 17 in 2004, and 17 in 2005. The surgery time was 140 minutes, 130 minutes (80-210) in radical nephrectomies, 135 minutes (120-150) in simple nephrectomies and 163 minutes (80-240) in the nephroureterectomy. Patients began an oral diet 1.7 days later, and were able to get up 1.7 days later. In the case of obese patients, they began an oral diet 2.3 days later and were able to get up (2.4 days) later than those non obese cases. (1.5 and 1.4 days respectively). The average stay has been 5.8 days (3-15). The average stay of the cases without complications was 4.2 days and those that encountered complications 9.7 days. In no cases was there a need for a blood transfusion. In 11.4% we had major complications with an average stay of 11.7 days. In 5.7% of cases there were reconversions, and 5.7% of cases were reoperated. 17.1% had minor complications, with an average stay of 8.8 daysConclusionsThe advantage of hand-assisted nephrectomy is that it allows one to begín a laparoscopy, with a reduced learning time, and with satisfactory results, allowing the incorporation of laparoscopy surgery in hospitals with a reduced annual volume.     

Hand-assisted laparoscopic nephrectomy

Hand-assisted surgery enjoys the benefits of open surgery while maintaining the post-operative advantages of laparoscopy. Logical indications for its application largely include those cases that require removal of a large amount of tissue intact. Hand-assisted laparoscopic surgery may find application in complex procedures such as radical, partial and difficult nephrectomies.     

Hand-assisted laparoscopic nephrectomy

The introduction of hand-assisted laparoscopy should benefit every laparoscopic urologist. Hand assistance will shorten the learning curve for many urologists interested in performing laparoscopic renal procedures, including nephrectomy and nephroureterectomy. Advanced laparoscopists will be able to undertake more challenging procedures, including nephrectomies for inflamed, infected kidneys and live-donor nephrectomies. A step-by-step approach is presented for hand-assisted laparoscopic nephrectomy.     

手助腹腔镜单纯性肾切除术的临床价值

目的 :探讨手助腹腔镜单纯性肾切除术的临床价值。方法 :采用手助腹腔镜行单纯性肾切除术 7例。结果 :7例手术均获成功 ,无术中和术后并发症发生。手术时间 85～ 30 0min ,平均 2 0 4min ;术中出血 30～2 0 0ml,平均 85ml;肾脏大小为 (14 .0cm× 8.5cm× 7.5cm)～ (2 4 .0cm× 2 0 .0cm× 10 .0cm) ;术后住院时间 6～15d。结论 :对于标准腹腔镜手术有难度的单纯性肾切除术 ,手助腹腔镜单纯性肾切除术 ,是一种可以选择的新的手术方式。     

Hand-assisted laparoscopic partial nephrectomy

BACKGROUND AND PURPOSE: The indications for partial nephrectomy are expanding as newer and more complete data come forth. A partial nephrectomy has traditionally required a generous flank incision. We report our experience using hand-assisted laparoscopy (HAL) as a less-invasive approach to partial nephrectomies. PATIENTS AND METHODS: Between October 1999 and May 2000, we performed 11 HAL partial nephrectomies. The average age of the patients was 55.7 years, the average body mass index was 25.6, and the average ASA class was 2.2. The indications for partial nephrectomy were enhancing solid renal lesions (N = 9) and nonfunctioning renal moiety in a duplicated system (N = 2). In the majority of cases, access to the renal pedicle was obtained prior to the partial nephrectomy. However, in no case did the renal artery or vein require occlusion. Several excisional techniques were employed, but all relied heavily on the Harmonic Scalpel in conjunction with the argon beam coagulator. Different hemostatic agents were applied to the renal defect, including Surgicel, Avitene, and fibrin-soaked Gelfoam activated by thrombin. In several instances, pledget reinforced sutures were placed in the renal capsule to aid with hemostasis. RESULTS: The average operative time was 273 minutes, the estimated blood loss 319 mL, and the change in hematocrit 7.3 points. No patient required a transfusion, and there was one conversion to open. Postoperatively patients, required an average of 35.6 mg of morphine sulfate equivalent and 8.2 narcotic tablets, resumed oral intake in 1.7 days, and were discharged home in 3.3 days. There were no major complications and only two minor complications. Postoperatively, five lesions were found to be benign, four lesions were confirmed to be malignant, and two lesions were consistent with a nonfunctioning duplicated renal moiety. Specimen size averaged 180 cc, and the tumor diameter averaged 1.9 cm. There were no positive surgical margins. CONCLUSIONS: Hand-assisted laparoscopic partial nephrectomy is feasible and reproducible. The surgeon's hand in the operative field facilitates dissection, vascular control, hemostasis, and suturing. Further long-term and prospective studies are underway.     

Hand-assisted laparoscopic donor nephrectomy

Background: The hand-assisted approach to laparoscopic donor nephrectomy (LDN) might minimize the learning curve and shorten both the operation and the warm ischemia time. Our initial results from hand-assisted LDN are presented and compared with data from the literature. Methods: From January to September 2000, ten hand-assisted LDNs of the right kidney were performed. Results: The median operation time was 140 min (range, 120--400 min), and the warm ischemia time was 2.5 min (range, 1--4 min). There were no conversions. Postoperative morbidity included one urinary tract infection. All but one patient returned to a normal diet within 48 h. Opiates were needed a maximum of 48 h. One recipient experienced initial loss of graft function as a result of unknown causes. Conclusions: Even at the beginning of the learning curve, operation time and warm ischemia time are significantly reduced by the hand-assisted approach, as compared with conventional LDN. apd: 3 April 2001     

Hand-assisted laparoscopic partial nephrectomy

The resurgence of nephron-sparing surgery for selected renal masses has fueled interest in minimally invasive approaches. Several authors have shown that laparoscopic partial nephrectomy is feasible if two goals are met: resection of the mass with negative margins and control of bleeding. The latter is a particular challenge, but numerous options are available. The authors describe the operative technique and the available results of hand-assisted laparoscopic partial nephrectomy.     

手助腹腔镜根治性肾切除19例报告

目的：探讨手助腹腔镜根治性肾切除术的临床应用价值。方法：采用手助腹腔镜根治性肾切除术治疗肾肿瘤19例。结果：19例手助腹腔镜手术均获成功。手术时间75～300min，平均165．8min；术中出血15～250ml，平均97．4ml；病理结果均为肾细胞癌(透明细胞癌18例，嫌色细胞癌1例)；术后住院时间6～23d。结论：手助腹腔镜根治性肾切除术治疗肾肿瘤是个可选择的新的手术方式，与开放手术相比，具有损伤小、出血少、术后恢复快等优点。     

Hand-assisted laparoscopic radical nephrectomy: the experience of the inexperienced

PURPOSE: We retrospectively examined the experience of novice laparoscopic surgeons performing hand-assisted laparoscopic radical nephrectomy. The purpose was to determine if urologists with minimal laparoscopic training could perform hand-assisted laparoscopic nephrectomies in a safe and efficient manner. MATERIALS AND METHODS: The first six hand-assisted laparoscopic radical nephrectomies performed by four different urology residents at the Chicago Lakeside VA hospital were reviewed. The residents included three chief urology residents and one postgraduate year 3 urology resident. None of the residents had taken any laparoscopic course, and all had limited exposure to the hand-assisted technique. In all cases, the residents performed the entire operation. The patients were evaluated for operative time, tumor size, body mass index, and ASA score. RESULTS: All six procedures were completed without conversion to the open technique. The average operating time was 215.8 minutes, and the time from incision to organ removal averaged 140.8 minutes. The average estimated blood loss was 166 mL. Complications included an intraoperative diaphragmatic injury (recognized and repaired laparoscopically) and one postoperative ileus. CONCLUSION: Hand-assisted laparoscopic radical nephrectomy can be performed safely and efficiently by urologists with minimal laparoscopic experience.     

Hand-assisted laparoscopic live donor nephrectomy

BACKGROUND: Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN. METHODS: Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided. RESULTS: The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1.0-4.5) min and the median blood loss was 50 (range 20-500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis. CONCLUSION: Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.