Hand-assisted laparoscopic nephrectomy for renal masses >9.5 cm: Series comparison with open radical nephrectomy

To assess the feasibility of hand-assisted laparoscopic nephrectomy (HALN) for large renal masses (stage T2, mean size 9.7 cm) and compare outcomes with a similar cohort undergoing open radical nephrectomy (ORN). A nonrandomized comparison of 19 consecutive patients who underwent nephrectomy for ren...

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Bibliographic Details
Published in:Urologic oncology 2005-09, Vol.23 (5), p.323-327
Main Authors: Malaeb, Bahaa S., Sherwood, Jennifer B., Taylor, Grant D., Duchene, David A., Broder, Kevin J., Koeneman, Kenneth S.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Female
Hand-assisted laparoscopy
Humans
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Kidneys
Laparoscopy - methods
Male
Medical sciences
Middle Aged
Nephrectomy
Nephrectomy - methods
Nephrology. Urinary tract diseases
Renal cell carcinoma
Renal neoplasm
Tumors
Tumors of the urinary system
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Summary:To assess the feasibility of hand-assisted laparoscopic nephrectomy (HALN) for large renal masses (stage T2, mean size 9.7 cm) and compare outcomes with a similar cohort undergoing open radical nephrectomy (ORN). A nonrandomized comparison of 19 consecutive patients who underwent nephrectomy for renal masses ≥7 cm was performed. The HALN group was compared to the ORN group regarding demographic parameters and perioperative data, including blood loss, operating time, narcotic usage, hematocrit change, return to standard oral intake, length of hospital stay, and complications. Data collected prospectively and statistics used 2-tailed t-test analysis. Patients underwent either ORN (mean tumor size 12.3 cm) or HALN (mean tumor size 9.7cm). Tumors up to 14 cm (n = 2) and pT3b, with renal vein thrombosis (n = 2), could be safely excised with HALN. There were no differences between the HALN and ORN groups regarding any demographic parameter. Blood loss, operating time, length of stay, parenteral narcotic use, and time to tolerating regular diet were all less statistically significant in the HALN group as compared to the ORN group ( P < 0.05). Tumors >15 cm necessitated ORN. HALN is technically feasible even for tumors with mean size >9.5 cm. There is a significant advantage to HALN over ORN regarding the intraoperative and postoperative morbidity. Tumors ≥15 cm should, in most cases, be performed with an open approach.
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2005.03.023