Laparoscopic Radical Nephrectomy: Prospective Assessment of Impact of Intact versus Fragmented Specimen Removal on Postoperative Quality of Life

Abstract

We prospectively compared postoperative recovery and quality of life for groups of patients undergoing laparoscopic radical nephrectomy with intact or fragmented specimen removal. A prospective evaluation of 12 patients having a transperitoneal laparoscopic nephrectomy was completed. In each case, a radical dissection was performed regardless of the surgical indication. Fragmented specimens (N = 7) were extracted at the umbilical port, and intact specimens (N = 5) were extracted through an infraumbilical incision. Demographic and perioperative data including specimen removal incision, narcotic requirements, and recovery interval were recorded. Subjective pain and activity assessments were administered prospectively on postoperative days 1, 2, 7, and 14. The mean incision length for intact specimen removal was 7.6 cm and that for fragmented removal was 1.2 cm (P < 0.05). Pain and activity self-assessments improved over time in each group. No significant differences in pain or activity scores were noted between treatment groups at any queried interval. Time to return of normal activity was not significantly different in the two groups. In this pilot study, no subjective or objective advantage was demonstrated for kidney fragmentation during laparoscopic radical nephrectomy. A larger randomized study is required to better assess any clinical advantage to specimen morcellation.