A prospective study of laparoscopic radical nephrectomy for T1 tumors - Is transperitoneal, retroperitoneal or hand assisted the best approach?

Robert B Nadler*, Stacy Loeb, J. Quentin Clemens, Robert A. Batler, Chris M. Gonzalez, Itay Y. Vardi

*Corresponding author for this work

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Purpose: We designed a prospective, randomized clinical trial to compare 3 common approaches to laparoscopic radical nephrectomy, namely transperitoneal, retroperitoneal and hand assisted. Materials and Methods: A total of 33 patients with a solid renal mass of 7 cm or less were prospectively enrolled in alternating fashion to a hand assisted procedure, a transperitoneal procedure with morcellation and a retroperitoneal procedure with intact specimen extraction. A single surgeon performed all operations. Preoperative, intraoperative and postoperative criteria were compared among the 3 techniques. Results: A total of 11 patients underwent each type of procedure. There was no significant difference in age, American Society of Anesthesiologists class, body mass index or tumor size among the groups. Mean operative time was significantly lower using the hand assisted approach, whereas estimated blood loss was similar in all 3 groups. Incision size, hospital stay and time to normal daily activity were less using the transperitoneal approach. While not significant, there was a trend toward less narcotic use in the transperitoneal group. Hernia formation was seen with increased frequency in the hand assisted group. Conclusions: In our series the hand assisted approach had significantly shorter operative time than the transperitoneal or retroperitoneal approach but it had the greatest risk of hernia formation. The transperitoneal approach was associated with a significantly shorter hospital stay and the earliest resumption of normal activity.

Original languageEnglish (US)
Pages (from-to)1230-1234
Number of pages5
JournalJournal of Urology
Volume175
Issue number4
DOIs
StatePublished - Jan 1 2006

Keywords

  • Kidney
  • Laparoscopy
  • Nephrectomy
  • Outcome assessment (health care)

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'A prospective study of laparoscopic radical nephrectomy for T1 tumors - Is transperitoneal, retroperitoneal or hand assisted the best approach?'. Together they form a unique fingerprint.

  • Cite this