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

Ramakrishna Venkatesh, Jay S. Belani, Cathy Chen, Chandru Sundaram, Sam B. Bhayani, Robert S. Figenshau, Jaime Landman

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives: 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). Methods: 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. Results: 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%). Conclusions: 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.

Original languageEnglish
Pages (from-to)873-877
Number of pages5
JournalUrology
Volume70
Issue number5
DOIs
StatePublished - Nov 2007

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Nephrectomy
Hand
Postoperative Pain
Equipment and Supplies
Kidney Neoplasms

ASJC Scopus subject areas

  • Urology

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Venkatesh, R., Belani, J. S., Chen, C., Sundaram, C., Bhayani, S. B., Figenshau, R. S., & Landman, J. (2007). Prospective Randomized Comparison of Laparoscopic and Hand-Assisted Laparoscopic Radical Nephrectomy. Urology, 70(5), 873-877. https://doi.org/10.1016/j.urology.2007.07.024

Prospective Randomized Comparison of Laparoscopic and Hand-Assisted Laparoscopic Radical Nephrectomy. / Venkatesh, Ramakrishna; Belani, Jay S.; Chen, Cathy; Sundaram, Chandru; Bhayani, Sam B.; Figenshau, Robert S.; Landman, Jaime.

In: Urology, Vol. 70, No. 5, 11.2007, p. 873-877.

Research output: Contribution to journalArticle

Venkatesh, R, Belani, JS, Chen, C, Sundaram, C, Bhayani, SB, Figenshau, RS & Landman, J 2007, 'Prospective Randomized Comparison of Laparoscopic and Hand-Assisted Laparoscopic Radical Nephrectomy', Urology, vol. 70, no. 5, pp. 873-877. https://doi.org/10.1016/j.urology.2007.07.024
Venkatesh, Ramakrishna ; Belani, Jay S. ; Chen, Cathy ; Sundaram, Chandru ; Bhayani, Sam B. ; Figenshau, Robert S. ; Landman, Jaime. / Prospective Randomized Comparison of Laparoscopic and Hand-Assisted Laparoscopic Radical Nephrectomy. In: Urology. 2007 ; Vol. 70, No. 5. pp. 873-877.
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AB - Objectives: 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). Methods: 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. Results: 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%). Conclusions: 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.

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