Comparison of Hand Assisted Versus Standard Laparoscopic Radical Nephrectomy for Suspected Renal Cell Carcinoma

Abstract

We compared standard and hand assisted laparoscopic radical nephrectomy for suspected renal cell carcinoma. We retrospectively reviewed 22 hand assisted and 16 standard laparoscopic radical nephrectomies performed for suspected renal cell carcinoma. Operative and recovery data were collected prospectively and from medical records as part of an institutional review board approved protocol. Patients completed pain, activity and the 12-item short form health related quality of life surveys preoperatively and postoperatively. Although patients undergoing hand assisted laparoscopic nephrectomy had larger tumors (mean 6.3 versus 4.1 cm., p = 0.009), tended toward greater corrected mean specimen weight (658 versus 482 gm., p = 0.111) and had greater medical co-morbidity (p = 0.0228), mean operative time for hand assisted laparoscopic procedures was significantly shorter (205 versus 270 minutes, p = 0.0004). With experience mean operative time decreased for standard but not for hand assisted laparoscopy (293 to 232 minutes, p = 0.0445, versus 206 to 204, p = 0.6162). Procedure type, surgeon experience and adrenal sparing were the only significant predictors of operative time. There was no difference in the groups in terms of the complication rate, hospital cost or stay, return to activity or overall pain score, or in the difference in preoperative and postoperative 12-item short form scores. Hand assisted laparoscopic nephrectomy tended to be associated with more abdominal pain early in convalescence and more wound complications but not significantly so. Hand assisted laparoscopic radical nephrectomy offers recovery, morbidity and cost that are comparable to those of standard laparoscopy. The benefits of the technique include shorter operative times, no need for specimen morcellation and direct manual control of the operative field. It is particularly useful early in surgeon experience, for large specimens or when patient co-morbidities require a rapid procedure.