Journal List > Korean J Urol > v.48(1) > 1004937

TOOLS
Choi and Chung: The Early Experience of Hand Assisted Laparoscopic Surgery in Nephroureterectomy
Original Article
Korean Journal of Urology

Korean Journal of Urology 2007; 48(1): 6-11.

Published online: 31 January 2007

DOI: https://doi.org/10.4111/kju.2007.48.1.6

The Early Experience of Hand Assisted Laparoscopic Surgery in Nephroureterectomy

Min Ho Choi, Han Chung

Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.

Corresponding author (urohana@gilhospital.com)

Received 3 July 2006       Accepted 11 October 2006

Copyright © 2007 The Korean Urological Association

Abstract

Purpose

Recently, the growing interest in minimally invasive surgery and the development of instruments and accompanying techniques have allowed laparoscopic surgery to be performed in a wide range of urological fields. Herein, the procedures and results of 6 cases of hand assisted laparoscopic surgery (HALS) nephroureterectomy are reported.

Materials and Methods

The records of 6 and 5 patients, who had undergone either a laparoscopic HALS nephroureterectomy, with bladder cuff excision, or an open nephroureterectomy, with bladder cuff excision, were reviewed.

Results

The mean operation times were 194 (150-210) and 280 (250-310) minutes in HALS nephroureterectomy and open nephroureterectomy, respectively. The average pain scales recorded with HALS and classical open surgery were 1.5 (max. 2) and 7 (max. 8), respectively, on the second post operative day.

Conclusions

HALS allows the operator to be notified with on-the-spot information and to have a feeling of complete control over the procedure, which helps to complete the operation in a shorter time, with the assistance of a tactile impression. Therefore, HALS can be concluded to be a better approach, which is a more acceptable procedure for the novice laparoscopic surgeon.

Keywords: Nephroureterectomy, Visual analogue pain scale

Figures and Tables

Fig. 1
Port sites of a HALS nephroureterectomy. A: first trocar, B: second trocar, H: hand port, HALS: hand assisted laparoscopic surgery, AAL: anterior axillary line, MAL: mid axillary line.
kju-48-6-g001
Table 1
The results of transperitoneal HALS and open nephroureterectomies in 11 patients
kju-48-6-i001

HALS: hand assisted laparoscopic surgery, HNU: HALS nephroureterectomy, ONU: open nephroureterectomy

Table 2
The result of HALS and open nephroureterectomies
kju-48-6-i002

HALS: hand assisted laparoscopic surgery

References

1. Cummings KB. Nephroureterectomy: rationale in the management of transitional cell carcinoma of the upper urinary tract. Urol Clin North Am. 1980. 7:569–578.
2. Lim DJ, Kim HH, Moon YH, Park YY, Yang SK, Yoon SJ, et al. Endourologic procedures and laparoscopic surgery in urology training hospitals : the report of nationwide survey. Korean J Urol. 2004. 45:714–719.
3. Baik S, Rho J, Kim CS. Comparison of hand-assisted laparoscopic donor nephrectomy with open donor nephrectomy. Korean J Urol. 2005. 46:1125–1129.
4. Chung HJ, Chiu AW, Chen KK. Retroperitoneoscopy assisted nephroureterectomy for the management of upper tract urothelial cancer. Min Inv Ther. 1996. 5:266–271.
5. Keeley FX Jr, Tolley DA. Laparoscopic nephroureterectomy: making management of upper-tract transitional cell carcinoma entirely minimally invasive. J Endourol. 1998. 12:139–141.
6. Salomon L, Hoznek A, Cicco A, Gasman D, Chopin DK, Abbou CC. Retroperito neoscopic nephroureterectomy for renal pelvic tumors with a single iliac incision. J Urol. 1999. 161:541–544.
7. Shalhav AL, Dunn MD, Portis AJ, Elbahnasy AM, McDougall EM, Clayman RV. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J Urol. 2000. 163:1100–1104.
8. Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg. 1991. 1:343–349.
9. Gaur DD. Laparoscopic operative retroperitoneoscopy: use of a new device. J Urol. 1992. 148:1137–1139.
10. Shalhav AL, Portis AJ, McDougall EM, Patel M, Clayman RV. Laparoscopic nephroureterectomy. A new standard for the surgical management of upper tract transitional cell cancer. Urol Clin North Am. 2000. 27:761–773.
11. McNeill SA, Chrisofos M, Tolley DA. The long-term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy. BJU Int. 2000. 86:619–623.
12. Gill IS, Soble JJ, Miller SD, Sung GT. A novel technique for management of the en bloc bladder cuff and distal ureter during laparoscopic nephroureterectomy. J Urol. 1999. 161:430–434.
13. Matsui Y, Ohara H, Ichioka K, Terada N, Yoshimura K, Terai A, et al. Retroperitoneoscopy-assisted total nephroureterectomy for upper urinary tract transitional cell carcinoma. Urology. 2002. 60:1010–1015.
14. Yoshino Y, Ono Y, Hattori R, Gotoh M, Kamihira O, Ohshima S. Retroper itoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter: Nagoya experience. Urology. 2003. 61:533–538.
15. Gill IS, Sung GT, Hobart MG, Savage SJ, Meraney AM, Schweizer DK, et al. Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: the Cleveland Clinic experience. J Urol. 2000. 164:1513–1522.
16. Kim DW, Ryu DS, Oh TH. Initial Experience of retroperitoneal laparoscopic nephroureterectomy for upper urinary tract transitional cell carinoma. Korean J Urol. 2005. 46:382–387.
17. Ko YL, Jang DS, Kim CS. Comparison of retroperitoneoscopic and open nephroureterectomy for upper tract transitional cell carcinoma. Korean J Urol. 2004. 45:1111–1115.
18. Jeong YR, Park HY, Lee TY. The early experience of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinomas. Korean J Urol. 2003. 44:28–33.
19. Kim HH. Laparoscopic surgery in urology (II). Korean J Urol. 2003. 44:1071–1081.
20. Terranova SA, Siddiqui KM, Preminger GM, Albala DM. hand-assisted laparo scopic renal surgery: hand-port incision complications. J Endourol. 2004. 18:775–779.
21. Wolf JS Jr, Merion RM, Leichtman AB, Campbell DA Jr, Magee JC, Punch JD, et al. Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation. 2001. 72:284–290.
22. Wolf JS Jr, Moon TD, Nakada SY. Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy. J Urol. 1998. 160:22–27.
23. Wolf JS Jr, Moon TD, Nakada SY. Hand-assisted laparoscopic nephrectomy: technical considerations. Tech Urol. 1997. 3:123–128.
24. Nakada SY, Moon TD, Gist M, Mahvi D. Use of the Pneumo sleeve as an adjunct in laparoscopic nephrectomy. Urology. 1997. 49:612–613.
25. Seifman BD, Montie JE, Wolf JS Jr. Prospective comparison between hand-assisted laparoscopic and open surgical nephroureterectomy for urothelial cell carcinoma. Urology. 2001. 57:133–137.
26. Jarrett TW, Chan DY, Cadeddu JA, Kavoussi LR. Laparoscopic nephrou reterectomy for the treatment of transitional cell carcinoma of the upper urinary tract. Urology. 2001. 57:448–453.
27. Munver R, Del Pizzo JJ, Sosa RE. Hand-assisted laparoscopic nephroureterectomy for upper urinary-tract transitional cell carcinoma. J Endourol. 2004. 18:351–358.
28. Wolf JS Jr, Dash A, Hollenbeck BK, Johnson WK 3rd, Madii R, Montgomery JS. Intermediate follow-up of hand assisted laparoscopic nephroureterectomy for urothelial carcinoma: factors associated with outcomes. J Urol. 2005. 173:1102–1107.
29. Lopez-pujals A, Leveillee RJ. Trocar arrangement for HALS. J Endourol. 2004. 18:319–325.
30. Okeke AA, Timoney AG, Keeley FX. Hand-assisted laparoscopic nephrectomy: complications related to the hand-port site. BJU Int. 2002. 90:364–367.
TOOLS
Similar articles