Journal List > Korean J Urol > v.47(10) > 1069757

Park, Jeong, and Kim: Laparoscopic Radical Nephrectomy for Renal Tumor: Comparison with Hand-assisted and Open Radical Nephrectomy

Abstract

Purpose:

We wanted to evaluate the safety and efficacy of standard laparoscopic radical nephrectomy (LRN) as compared to hand-assisted laparoscopic radical nephrectomy (HALS) and open radical nephrectomy (ORN) when the three different procedures were all performed by a single experienced surgeon.

Materials and Methods:

Between May 2000 and September 2005, 62 consecutive patients with renal tumor underwent LRN (16 patients), HALS (18 patients), or ORN (32 patients) by a single surgeon who had performed more than 100 laparoscopic surgeries. The surgical results such as the operation time, estimated blood loss (EBL), transfusion rate, narcotic analgesia requirement, hospital stay and complications, and pathologic results were reviewed retrospectively.

Results:

The LRNs and HALSs were successfully performed for all patients without open conversion. The final pathologic reports showed renal cell carcinomas in 65 cases and oncocytoma in 1 case. There were no significant differences of demographic data between the three groups. For the LRN, HALS, and ORN patients, the mean tumor size was 2.8cm (1.3-8.5), 4.5cm (1.5-13.5) and 5.6cm (1.0-12.5), respectively, the mean weight of the removed kidney was 200.6g (63-375), 214.5g (122-444.3) and 367.0g (122-823), respectively, the mean operation time was 174.8 min. (125-232), 196.4 min. (150-350) and 157.7 min. (110-265), respectively, the EBL was 140ml (50400), 108ml (50-600) and 297ml (50-700), respectively, the transfusion rate was 0%, 5.6% and 15.6%, respectively, the narcotic analgesia requirement was 20mg, 15mg and 43mg of morphine sulfate, respectively, the postoperative hospital stay was 4.8 days, 5.2 days and 10.5 days respectively, and the number of complication was 1/16 cases (6.3%), 1/18 cases (5.6%) and 4/32 cases (12.5%) respectively. The surgical and pathological parameters of LRN showed no significant difference compared to those of the HALS.

Conclusions:

LRN for renal tumors was less invasive than ORN and it showed similar surgical results to HALS. Therefore standard laparoscopic radical nephrectomy is considered to be an effective and safe treatment modality for renal tumors. (Korean J Urol 2006;47:1046-1051)

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Fig. 1.
Trocar placement for standard and hand-assisted laparoscopic radical nephrectomy.
kju-47-1046f1.tif
Table 1.
Patient characteristics
  LRN HALS ORN Ρ
No. of patients 16 18 32 -
No. Male/Female 12/4 11/7 25/7 0.42
Mean age (range) 55.2 (32-75) 52.4 (27-79) 54.1 (35-77) 0.78
BMI (range) 23.96(19.12-30.31) 24.07(18.34-28.91) 24.44 (18.37-32.49) 0.95
ASA score 1/2/3 5/11/0 9/9/0 9/21/2 0.36
Operative side Rt/Lt 4/12 6/12 18/14 0.08

ASA: American Society of Anesthesiologists, BMI: body mass index, LRN: laparoscopic radical nephrectomy, HALS: hand-assisted laparoscopic radical nephrectomy, ORN: open radical nephrectomy

Table 2.
Pathologic outcomes
  LRN∗ HALS ORN Ρ
T stage (%)
  1 15 (93.8) 15 (88.2) 20 (62.5)  
  2 1 (6.2) 1 (5.9) 4 (12.5) 0.08
  3 0 (0) 1 (5.9) 8 (25)  
Long diameter of mass 2.8 (1.3-8.5) 4.5 (1.2-13.5) 5.6 (1.0-12.5) <0.01
Weight of specimen 200.6 (63-375) 214.5 (122-444.3) 367.0 (122-823) <0.01

: the final pathologic reports showed oncocytoma in 1 case in HALS group. LRN: laparoscopic radical nephrectomy, HALS: hand-assisted laparoscopic radical nephrectomy, ORN: open radical nephrectomy

Table 3.
Surgical outcomes
  LRN HALS ORN Ρ
Hospital stay (range) 4.8 (3-7)∗ 5.2 (4-9) 10.5 (5-91) <0.01
Morphine sulfate (mg) 20∗ 15 43 <0.01
Operation time 174.8 (125-232)∗ 196.4 (150-350) 157.7 (110-265) <0.01
EBL (ml) 140 (50-400)∗ 108 (50-600) 297 (50-700) <0.01
Transfusion (%) 0/16 (0)∗ 1/18 (5.6) 5/32 (15.6) 0.17
Oral intake 2.0 (1-4)∗ 2.6 (1-5) 2.4 (1-5) 0.27
Complication (%) 1 (6.3)∗ 1 (5.6) 4 (12.5) 0.65

means p>0.05 relative to HALS. EBL: estimated blood loss, LRN: laparoscopic radical nephrectomy, HALS: hand-assisted laparoscopic radical nephrectomy, ORN: open radical nephrectomy

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