HAND ASSISTED LAPAROSCOPIC NEPHRECTOMY - COMPARISON TO STANDARD LAPAROSCOPIC NEPHRECTOMY

Purpose: We report our initial experience with hand assisted laparosco pic nephrectomy, and compare it to our results of standard laparoscopi c nephrectomy. Materials and Methods: The results of 21 hand assisted and standard laparoscopic nephrectomies (15 simple and 4 radical nephr ectomies, and 2 nephroureterectomies) were reviewed. Hand assisted lap aroscopic nephrectomy was performed with a hand placed intra-abdominal ly using the Pneumo Sleeve, in addition to standard laparoscopic inst ruments manipulated through laparoscopic ports. Standard laparoscopic nephrectomy was performed using laparoscopic instruments alone. Periop erative data were recorded and questionnaires, including visual analog pain scales, were administered prospectively to 17 of 21 cases. Resul ts: The average operative time for 13 hand assisted laparoscopic nephr ectomies was 240 minutes, which was significantly less than the 325-mi nute average for 8 standard laparoscopic nephrectomies (p = 0.04). Maj or complications tended to be more frequent in the standard group (38 versus 8%, p = 0.10). Hospital stay, return to normal activity and cor rected 2-week abdominal/flank pain score in the hand assisted group (3 .1 days, 14 days and 0.8, respectively) were not significantly differe nt from the standard group (3.0 days, 10 days and 0.2, respectively). Conclusions: Compared to standard laparoscopic techniques, hand assist ance appears to facilitate the operative speed and safety of laparosco pic nephrectomy without sacrificing the benefits of minimally invasive surgery. Hand assistance may make laparoscopic nephrectomy more appea ling to urologists without advanced laparoscopic experience, may facil itate the laparoscopic management of demanding pathological conditions and is particularly useful when intact specimens are required. Hand a ssistance, by improving manipulative ability and tactile sense, is hel pful for select cases of laparoscopic nephrectomy.