Prospective comparison between hand-assisted laparoscopic and open surgical nephroureterectomy for urothelial cell carcinoma

Objectives. To prospectively compare open surgical and the new hand-assiste d approach to laparoscopic nephroureterectomy for urothelial cell carcinoma . Previous retrospective studies have suggested that standard laparoscopic nephroureterectomy provides a briefer convalescence than open surgical neph roureterectomy. Methods. Between March 1997 and September 1999, 16 hand-assisted laparoscop ic and 11 open surgical nephroureterectomies were performed, without random ization. Validated questionnaires were prospectively administered preoperat ively and 2 and 6 weeks postoperatively. Results. The operative time was longer with the laparoscopic approach (320 versus 199 minutes, P <0.001), but the hospital stay was shorter (3.9 versu s 5.2 days, P = 0.03). Patient recovery favored the laparoscopic group with regard to time to drive (17.1 versus 37.7 days), time to normal, nonstrenu ous activity (18.2 versus 38.1 days), and the mental component score of the SF-12 survey at 6 weeks (57.1 versus 43.0) (P <0.05 for all). Minor compli cations occurred in 19% of the laparoscopic and 45% of the open surgical pr ocedures; major complications occurred in 19% of laparoscopic and 27% of op en surgical procedures (P >0.1 for both). Cancer control was similar betwee n both groups. The mean operating room cost was 56% more for the laparoscop ic group (P <0.001), but the overall hospital cost was only 8% greater (P > 0.3). Conclusions. Hand-assisted laparoscopic nephroureterectomy is a safe and ef fective alternative to an open surgical approach. Indexes of patient recove ry suggest that patient convalescence is less than after an open surgical n ephroureterectomy. Increased operative costs may be offset by a shorter hos pital stay and fewer complications, resulting in similar overall hospital c osts. UROLOGY 57: 133-137, 2001. (C) 2001, Elsevier Science Inc.