Hand-assisted Laparoscopic Radical Nephrectomy Research Articles

Safety and oncological outcomes for large (stage ≥T2b) and locally advanced renal cell carcinoma: comparison between laparoscopic and modified hand-assisted laparoscopic radical nephrectomy.

ObjectiveTo compare the operative and oncologic outcomes between hand-assisted laparoscopic radical nephrectomy (HALRN) and laparoscopic radical nephrectomy (LRN) for large (stage ≥T2b) and locally advanced renal cell carcinoma.MethodsWe retrospectively collected data from patients who underwent HALRN or LRN for stage ≥T2b renal cell carcinoma from January 2011 to January 2018 in our institution. The patients’ demographics, perioperative parameters, and postoperative follow-up data were compared between the two groups. The survival outcome was estimated using the Kaplan–Meier method.ResultsThe HALRN group comprised 78 patients, and the LRN group comprised 63 patients. The median operative duration was significantly shorter in the HALRN than LRN group. The two groups were equivalent in terms of the incision length, blood loss, complication rate, and duration of hospitalization. In the HALRN and LRN groups, the 5-year overall survival rates were 69.4% and 73.1%, the 5-year cancer-specific survival rates were 80.0% and 83.3%, and the 5-year progression-free survival rates were 66.4% and 74.7%, respectively, with no significant differences.ConclusionsCompared with LRN, HALRN may offer a shorter operative duration and equivalent surgical outcomes without sacrificing oncological efficacy. In addition, HALRN has specific advantages for extremely large and complicated renal tumors.

The Surgical Treatment and Genomic Analysis of a Rare Case of Oligometastatic Renal Cell Carcinoma of the Prostate

An 80-year-old male presented to the emergency department after an episode of gross hematuria 4 hours prior. Review of systems at the emergency department was positive for dysuria and chronic obstructive urinary symptoms while negative for fevers, chills, or flank pain. Of note, his past medical history includes atrial fibrillation on rivaroxaban anticoagulation, left bundle branch block, coronary artery disease (status postdrug-eluting stent placement to the left circumflex artery in 2003 and drug-eluting stent placement to the left anterior descending artery in 2013), peripheral vascular disease (status post bilateral iliac artery stent placements in 2009), chronic obstructive pulmonary disease, hyperlipidemia, gout, nephrolithiasis, and left renal cell carcinoma (RCC) status post left hand-assisted laparoscopic radical nephrectomy in 2003.

A Rare Case of the Simultaneous, Multifocal, Metastatic Renal Cell Carcinoma to the Ipsilateral Left Testes, Bladder, and Stomach.

We describe the rare case of a 68-year-old gentleman with the history of a hand-assisted laparoscopic left radical nephrectomy for a T2bN0M1 clear cell renal cell carcinoma (RCC). Seven years after surgery and with clean surveillance imaging for metastasis/recurrence the patient presented with three separate tumors suspicious for malignancy. A bladder lesion was found during workup for hematuria, a stomach lesion during diagnostic endoscopy, and a testicular lesion during self-exam. He underwent transurethral resection of bladder tumor, left inguinal orchiectomy, and upper endoscopic ensnarement. All specimens surprisingly showed RCC by histology and immunostaining. These three sites are rare for RCC metastasis and simultaneous presentation is even rarer, further emphasizing the importance of continuous and careful follow-up in this patient population, despite what could appear as complete remission.

Robotic radical nephrectomy for renal cell carcinoma: a systematic review.

BackgroundLaparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN.MethodsA Medline search was performed between 2000–2013 with the terms “robotic radical nephrectomy”, “robot-assisted laparoscopic nephrectomy”, “radical nephrectomy”. Six RRN case-series and four comparative studies between RRN and (ON)/pure or hand-assisted LRN were identified.ResultsCurrent literature produces a low level of evidence for RRN in the treatment of RCC, with only one prospective study available. Mean operative time (OT) ranges between 127.8-345 min, mean estimated blood loss (EBL) ranges between 100–273.6 ml, and mean hospital stay (HS) ranges between 1.2-4.3 days. The comparison between RRN and LRN showed no differences in the evaluated outcomes except for a longer OT for RRN as evidenced in two studies. Significantly higher direct costs and costs of the disposable instruments were also observed for RRN. The comparison between RRN and ON showed that ON is characterized by shorter OT but higher EBL, higher need of postoperative analgesics and longer HS.ConclusionsNo advantage of robotics over standard laparoscopy for the treatment of clinically localized RCC was evidenced. Promising preliminary results on oncologic efficacy of RRN have been published on the T3a-b disease. Fields of wider application of robotics should be researched where indications for open surgery still persist.

91 Obesity and morbid obesity are associated with a greater conversion rate to open surgery for standard but not hand assisted laparoscopic radical nephrectomy

91 Obesity and morbid obesity are associated with a greater conversion rate to open surgery for standard but not hand assisted laparoscopic radical nephrectomy

Cox-2 gene overexpression in ureteral stump urothelial carcinoma following nephrectomy for renal cell carcinoma: a case report.

IntroductionA primary ureteral stump tumor after a nephrectomy is rare; urothelial carcinoma of the ureteral stump after a nephrectomy for renal cell carcinoma is even rarer. A thorough review of the literature indicated that only seven cases have previously been reported. In this study, we report the first Taiwanese case of urothelial carcinoma of the ureteral stump after a nephrectomy. It is also the first female case in the literature. The relationship between inflammatory genes, medication history and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma has not been reported.Case presentationA 72-year-old Asian Taiwanese women with chronic hepatitis C, liver cirrhosis and chronic kidney disease underwent a hand-assisted laparoscopic radical nephrectomy in 2001 due to renal cell carcinoma. Nine years later, she was diagnosed with ureteral stump urothelial carcinoma. Genetic and medication surveys were performed. Importantly, our patient had taken Chinese herbal drugs for more than 10 years and the inflammatory gene, Cox-2, was highly expressed in this patient. This is the first report to study the relationship between the Cox-2 gene and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma.ConclusionLong-term multiple use of Chinese herbal drugs could be one of the important risk factors for developing urothelial cancer. Close functional coupling between Chinese herbal drugs, Cox-2 gene activation and urothelial cancer should be further investigated.

Renal Cell Carcinoma in a Right Malrotated Kidney

The authors report a case of renal cell carcinoma in a right malrotated (horizontal axis) kidney. The patient was treated by hand-assisted laparoscopic radical nephrectomy. This is the first report of a horizontal axis malrotated kidney with renal cell carcinoma.

Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

Excision of renal cell carcinoma (RCC) with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.

MP-14.08: Analysis of Operative Outcomes in 100 Hand-Assisted Laparoscopic Radical Nephrectomies (HALRN)

There are 3 major advantages of hand-assisted laparoscopic radical nephrectomy(HALRN). The first one is to get a tactile sensation of renal and perirenal spaces including internal organs with 3 dimensional perception. The second one is to get a cancer control with pathologic specimen. The third one is to improve the quality of life including reducing pain and skin incision. The aims of this study are to present the clinical outcomes of 100 patients who underwent HALRN and to evaluate the efficiency of HALRN.

Comparison of Hand-Assisted Laparoscopic Radical Nephrectomy with Open Radical Nephrectomy for pT1-2 Clear Cell Renal-Cell Carcinoma: A Multi-Institutional Study

This multiinstitutional report assesses the oncologic efficacy of hand-assisted laparoscopic radical nephrectomy (HLRN) compared with open radical nephrectomy (ORN) in patients with localized clear cell renal-cell carcinoma (RCC). We analyzed the data from 2561 patients who underwent radical nephrectomy at 26 institutions in Korea between June 1998 and December 2007 for localized RCC. One hundred ninety-seven patients with clear cell RCC in the HLRN group were compared with 917 patients with clear cell RCC in the ORN group. To evaluate the technical adequacy and oncologic outcome, we compared the operative time, estimated blood loss, and 5-year overall and disease-free survival rates. The median follow-up was 36 months for the HLRN group and 27 months for the ORN group. The operative time was significantly longer in the HLRN group than in the ORN group (206.8 +/- 68.7 minutes vs. 179.1 +/- 61.5 minutes, p < 0.001), and blood loss was significantly lower in the HLRN group than in the ORN group (311.6 +/- 238.7 mL vs. 372.4 +/- 367.3 mL, p = 0.003). There was no significant difference in pathologic T stage and Fuhrman's nuclear grade in the two groups. No statistically significant difference was found in the 5-year overall (91.2% vs. 90.3%, p = 0.286) and disease-specific (95.2% vs. 92.1%, p = 0.222) survival rates between the HLRN and ORN groups. Despite the longer operative time, HLRN was an effective and less-invasive treatment option for localized clear cell RCC. HLRN could achieve cancer control similar to that obtained with ORN.

Approach and Specimen Handling Do Not Influence Oncological Perioperative and Long-Term Outcomes After Laparoscopic Radical Nephrectomy

We assessed the impact of approach (standard vs hand assisted) and specimen handling (morcellation vs intact extraction) on laparoscopic radical nephrectomy short-term recovery and long-term oncological outcome. Of 255 patients with pathologically confirmed and presumed localized renal cell carcinoma 147 underwent standard and 108 underwent hand assisted laparoscopic radical nephrectomy. Specimen handling was done by intact extraction in 132 cases and morcellation in 123. Perioperative data were recorded prospectively and oncological surveillance was reviewed retrospectively. Despite significant differences in body mass index, mass size, T stage and pathological risk between the groups there were no statistically significant differences in perioperative outcome by approach or specimen handling except greater estimated blood loss (mean 406 vs 283 ml), longer hospital stay (mean 2.8 vs 2.4 days) and greater time to recovery (mean 13 vs 9.9 days) in the hand assisted vs the standard group. Discovery of pT3 disease was not significantly different between the specimen handling groups after controlling for mass size. Multivariate analysis of 5-year Kaplan-Meier survival curves revealed that neither approach nor specimen handling impacted recurrence-free, cancer specific or overall survival. Differences in perioperative outcomes attributable to the specific approach (standard vs hand assisted) and the method of specimen handling (morcellation vs intact extraction) at laparoscopic radical nephrectomy have minimal clinical significance. There are no discernible differences in long-term oncological efficacy. The choice of approach and specimen handling for laparoscopic radical nephrectomy can be based on surgeon and patient preference, cosmetic considerations and other factors.

Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

No consensus has yet been established regarding the best minimally invasive access for radical ablation of renal tumors. Our objective was to prospectively compare the surgical results and oncologic management of two currently used endoscopic techniques. Over a four-year period, 50 patients with renal tumors and clinical stage T1b-T2, smaller than 12 cm, underwent a radical nephrectomy at two reference institutions, 25 underwent retroperitoneoscopic radical nephrectomy (RRN) and 25 a hand-assisted laparoscopic radical nephrectomy (HALRN). Mean follow-up of both cohorts was 50 months. Operative parameters and oncological management were compared. The mean operative time was 180 min in RRN and 108 min in HALRN (p < 0.001). The time required to access the renal pedicle in RRN was 30 min. and in HALRN 40 min., Learning curve was shorter in HALRN than RRN. Mean blood loss was 100 mL in RRN and 242 mL in HALRN. Mean incision size for specimen retrieval in RRN was 6.5 cm and in HALRN 7.5 cm. One patient with intra operative occurrence of ascites and subsequent pathological stage pT2N0M0 grade 3 operated via HALRN, had neoplasic implants in the Hand-port incision 3 months after surgery followed by death 4 months after recurrence. One patient, with pathological stage pT3N0M0 grade 3 in RRN had metastasis after 36 months. Both, RRN and HALRN techniques are accepted minimally invasive options for endoscopic radical nephrectomy with equivalent long term oncological outcome in the treatment of renal tumors.

Oncological and Surgical Outcomes of Pure Laparoscopic Radical Nephrectomy and Hand-Assisted Laparoscopic Radical Nephrectomy for pT1 Renal Cell Carcinoma: Comparison with Open Radical Nephrectomy

Purpose: We compared the surgical and oncologic outcomes of pure laparoscopic radical nephrectomy (PLRN) and hand-assisted laparoscopic radical nephrectomy (HLRN) with those of open radical nephrectomy (ORN) in patients with pT1 renal cell carcinoma (RCC). Materials and Methods: Between 1999 and 2007, a total of 269 patients underwent PLRN (n=77), HLRN (n=87), and ORN (n=105) for pT1 RCC. Follow-up data consisted of clinical, pathologic, and oncologic results and were reviewed retrospectively. Kaplan-Meier survival curves were constructed for progression and survival endpoints. Results: Mean operative time was 184.0, 164.0, and 132.6 minutes (p< 0.001); mean estimated blood loss was 196.7, 147.8, and 232.6 ml (p<0.001); and mean postoperative hospital stay was 5.7, 7.2, and 7.8 days (p<0.001) for the PLRN, HLRN and ORN groups, respectively. The major complication rate after surgery was 2.6%, 2.3%, and 3.8%, respectively (p=0.807). Median follow-up periods were 32 months in the PLRN group, 48 months in the HLRN group, and 37 months in the ORN group. Five-year progression-free survival was 97.4%, 96.6%, and 98.1% (p=0.557), and 5-year cancer-specific survival was 98.7%, 96.6%, and 98.1% (p=0.508), respectively. Conclusions: PLRN and HLRN are safe treatment options with comparable oncologic results to ORN for pT1 RCC. (Korean J Urol 2009;50:457-462) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Obesity and Morbid Obesity are Associated With a Greater Conversion Rate to Open Surgery for Standard but Not Hand Assisted Laparoscopic Radical Nephrectomy

We noted that the impact of obesity on renal laparoscopy may vary with the specific surgical approach. Patients who underwent standard and hand assisted laparoscopic radical nephrectomy at our institution were categorized by body mass index as nonobese--body mass index less than 30, obese--30 to 39.9 and morbidly obese--40 kg/m(2) or greater. We assessed the association of intraoperative and postoperative outcomes with body mass index for standard and hand assisted laparoscopic radical nephrectomy. Of 350 patients who underwent standard (196) or hand assisted (154) laparoscopic radical nephrectomy 36% were obese and 12% were morbidly obese. Patients who underwent hand assisted laparoscopic radical nephrectomy had a greater body mass index, more frequent assignment of American Society of Anesthesiologists score 3 or 4 and larger masses than those who underwent standard laparoscopic radical nephrectomy. Despite this fact conversion to open surgery from hand assisted laparoscopic radical nephrectomy did not occur, while such conversion occurred in the standard laparoscopic radical nephrectomy group in 0.8% of nonobese, 3.0% of obese and 17% of morbidly obese patients (association with body mass index p = 0.003). Operative time, intraoperative and postoperative complications, and hospitalization duration did not vary with body mass index. On multivariate analysis only body mass index and not age, gender, American Society of Anesthesiologists score, prior abdominal surgery or tumor size was associated with an increasing likelihood of conversion to open surgery (p = 0.04), and only in the standard laparoscopic radical nephrectomy group. Although obesity and morbid obesity are associated with more frequent conversion to open surgery during standard laparoscopic radical nephrectomy, such conversion did not occur during hand assisted laparoscopic radical nephrectomy. This advantage of hand assisted laparoscopic radical nephrectomy should be considered when planning laparoscopic radical nephrectomy in obese and morbidly obese patients.

Health-related quality of life after hand-assisted laparoscopic and open radical nephrectomies of renal cell carcinoma

To compare the health-related quality of life (HRQOL) in contemporaneous groups of patients undergoing hand-assisted laparoscopic radical nephrectomy (HALRN) or open radical nephrectomy (ORN) for renal cell carcinoma (RCC). The clinical data of 20 cases receiving hand-assisted laparoscopic radical nephrectomy (the HALRN group) and 51 cases receiving open radical nephrectomy (the ORN group) were analyzed retrospectively and health questionnaires were mailed to these patients at 1 year postoperatively. The two groups were compared in terms of general surgery-related information, tumor characteristics, days to return to work or routine daily activities, and health-related quality-of-life scales. Patients in the HALRN group had significantly less mean incision length (6.25 versus 17.8 cm), faster return to work or routine daily activities (5.3 versus 8.6 weeks), and earlier out-of-bed activity (4.76 versus 6.59 days) compared with those in the ORN group (P < 0.05). There were no significant differences in HRQOL scales at 1 year between the both groups (P > 0.05). The results showed that hand-assisted laparoscopic surgery is a minimally invasive surgical technique for RCC offering earlier recovery and similar long-term HRQOL compared with open surgery.

ONCOLOGICAL OUTCOMES OF HAND‐ASSISTED LAPAROSCOPIC RADICAL NEPHRECTOMY FOR CLINICALLY LOCALIZED RENAL CELL CARCINOMA: A SINGLE INSTITUTION STUDY WITH ≥3 YEARS OF FOLLOW‐UP

OBJECTIVE To evaluate the intermediate-term outcomes of hand-assisted laparoscopic radical nephrectomy (HALRN) for clinically organ-confined renal cell carcinoma (RCC). PATIENTS AND METHODS We retrospectively reviewed patients who had HALRN for clinically organ-confined RCC at the University of Wisconsin from 1996 to 2003. All patients with pathologically confirmed RCC and with ≥3 years of follow-up were included in a retrospective chart review of variables before, during and after HALRN, as well as the clinical outcomes. RESULTS In all, 75 patients had HALRN in the study period; their mean age was 59 years, body mass index 29 kg/m2, operative duration 227 min, estimated blood loss 130 mL, and none required conversion to open nephrectomy. The median time to first oral intake was 2.5 days and the median hospital stay 4 days. On pathological examination the mean tumour size was 5.8 cm; 70% were pT1, 26% pT2 and 4% pT3; 82% were clear cell, 9% papillary, 8% chromophobe and 1% collecting duct carcinoma. Of the 65 patients who had a follow-up of ≥36 months (mean 46, range 36–117), the 3- and 5-year disease-free survival rate was 93.4% and 90.2%, respectively; the 3- and 5-year cancer-specific survival rate was 96.5% and 94.4%, respectively. CONCLUSION Our study suggests that HALRN is a safe and minimally invasive treatment for managing clinically organ-confined RCC, with good intermediate-term oncological outcomes.

Primary Synovial Sarcoma of the Kidney

Primary synovial sarcoma arising from the kidney is extremely rare. We report two cases with primary renal synovial sarcoma. Both were initially diagnosed as renal cell carcinoma. The first case was a 30-year-old woman who presented with right flank soreness. Ultrasonography disclosed a multiloculated cystic tumor measuring 9 x 7 cm. She underwent hand-assisted laparoscopic radical nephrectomy; there was no recurrence during 15 months of follow-up. The second case was a 49-year-old woman who presented with a palpable mass in the left upper quadrant of the abdomen of 1 month's duration. Computed tomography showed a heterogeneously enhanced tumor measuring 13 x 11 cm at the left retroperitoneum with displacement of the pancreas and the left kidney. Hand-assisted retroperitoneoscopic radical nephrectomy was performed. She had no evidence of recurrence after 27 months of follow-up. Pathology of the two cases showed histologic and immunochemical features of synovial sarcoma with coexisting spindle and epithelial cells. Physicians should be aware of the possibility of malignancy in cystic renal masses and that synovial sarcoma is one of the possibilities.

Laparoscopic renal surgery in the octogenarian

To describe our experience with laparoscopic renal surgery (LRS) in the octogenarian. Octogenarians are generally suboptimal surgical candidates but the recent upsurge of minimally invasive options for the management of kidney lesions, such as laparoscopic excision, cryoablation and radiofrequency ablation (RFA), have changed that perception. In all, 26 patients aged >or=80 years underwent LRS at Brown University and the University of Wisconsin between 2000 and 2006. Demographic information, anatomical location, tumour stage, comorbidities, type of laparoscopic approach, management and outcomes were assessed. Complications during and after LRS, hospital stay, analgesia requirements and return to normal activity were analysed. The mean age of the patients was 81 years. The procedures performed included hand-assisted laparoscopic partial nephrectomy (three patients), hand-assisted laparoscopic radical nephrectomy (10), hand-assisted laparoscopic nephroureterectomy (four), laparoscopic-assisted cryoablation (seven), laparoscopic RFA (one), and laparoscopic unroofing of a renal cyst (one). The mean (range) follow-up was 40 (8-84) months. The mean American Society of Anesthesiologists score was 2.5. The average hospital stay was 5.6 days and the mean time to normal activity after discharge was 19 days. There were two major and five minor complications. Nineteen of 22 patients evaluable had no evidence of disease at the last follow-up. The three deceased patients died of unrelated causes. LRS in the octogenarian is safe to perform in patients with multiple comorbidities. The major and minor complication rates were 7% and 19%, respectively. Recent trends show that ablative procedures are being performed more commonly than surgical excision in this age group.

Evaluation of the Impact of Body Mass Index on Outcome among Renal Mass Patients Treated with Hand-Assisted Laparoscopic Radical Nephrectomy

Although there are empiric data to show that obesity is not a contraindication for laparoscopic radical nephrectomy, similar data are lacking for the use of hand-assisted laparoscopic radical nephrectomy (HALRN) in obese patients. We evaluate whether obese patients undergoing HALRN to manage a renal mass are more likely than nonobese patients to experience poor intraoperative and perioperative outcomes. Between June 1, 1999, and May 31, 2006, 150 patients underwent HALRN for the management of a solid renal mass at our institution. We abstracted detailed demographic, clinical, and follow-up data on all patients in this cohort. As our primary analysis, we evaluated associations between body mass index (BMI) and estimated blood loss, operative time, length of stay, and complications using linear and logistic regression models. There was no evidence that obese patients experienced a statistically significant or clinically relevant increase in blood loss (P = 0.97), operative times (P = 0.87) or length of stay (P = 0.62) compared with persons of normal weight. In contrast, although there was no evidence of a linear trend toward complications in patients with a higher BMI (P = 0.19), obese patients were almost three times more likely to experience a complication compared with normal-weight persons (odds ratio: 2.88; 95% confidence interval: 1.01-8.16). Adjusting for relevant clinical covariates individually did not markedly alter these associations. Obesity is not a contraindication for HALRN to manage a renal mass; however, obese patients should be aware that they may be at increased risk for certain complications after surgery, notably ileus and incisional hernias.

Prospective Randomized Comparison of Laparoscopic and Hand-Assisted Laparoscopic Radical Nephrectomy

The majority of localized renal cancers are currently managed by laparoscopic radical nephrectomy, with or without the hand-assist device. In this prospective randomized study, we evaluated the patient outcomes with a standard laparoscopic radical nephrectomy (LRN) versus a hand-assisted laparoscopic radical nephrectomy (HALN). Over a 3-year period, we randomly assigned 21 patients with a localized renal mass of 10 cm or larger to a LRN group with intact specimen extraction or a HALN. The trocar size and sites, the position of the hand-assist device, and the specimen extraction sites were standardized. Patient characteristics, surgical complications, postoperative pain, and convalescence were evaluated. Twelve patients underwent LRN and 9 patients underwent HALN. Both groups had similar body mass indices (BMI), mean tumor diameter (LRN, 5.8 cm; HALN, 5.6 cm), and American Society of Anesthesiologists (ASA) scores. The HALN cohort was significantly older (mean age = 68 years) than the LRN cohort (mean age = 54 years) (P = 0.019). Perioperatively, both groups had similar mean times to oral intake and discharge (LRN 2.6 days and HALN 3 days, P = 0.6). Although both groups reported similar postoperative pain scale scores on day 1, at 1 and 3 months. Two patients in each group had complications (LRN 16% and HALN 22%). In comparing HALN and LRN, there was no difference in the majority of operative and postoperative parameters, including hospital stay and postoperative pain. However, LRN patients had a significantly shorter convalescence with quicker return to normal activities and work than the HALN group. Part of the delay in long-term convalescence parameters may be due to the older patients in the HALN cohort.