Laparoscopic radical nephrectomy for renal tumor: Comparison with hand-assisted and open radical nephrectomy

Purpose: We wanted to evaluate the safety and efficacy of standard laparoscopic radical nephrectomy (LRN) as compared to hand-assisted laparoscopic radical nephrectomy (HALS) and open radical nephrectomy (ORN) when the three different procedures were all performed by a single experienced surgeon. Materials and Methods: Between May 2000 and September 2005, 62 consecutive patients with renal tumor underwent LRN (16 patients), HALS (18 patients), or ORN (32 patients) by a single surgeon who had performed more than 100 laparoscopic surgeries. The surgical results such as the operation time, estimated blood loss (EBL), transfusion rate, narcotic analgesia requirement, hospital stay and complications, and pathologic results were reviewed retrospectively. Results: The LRNs and HALSs were successfully performed for all patients without open conversion. The final pathologic reports showed renal cell carcinomas in 65 cases and oncocytoma in 1 case. There were no significant differences of demographic data between the three groups. For the LRN, HALS, and ORN patients, the mean tumor size was 2.8cm (1.3-8.5), 4.5cm (1.5-13.5) and 5.6cm (1.0-12.5), respectively, the mean weight of the removed kidney was 200.6g (63-375), 214.5g (122-444.3) and 367.0g (122-823), respectively, the mean operation time was 174.8 min. (125-232), 196.4 min. (150-350) and 157.7 min. (110-265), respectively, the EBL was 140ml (50-400), 108ml (50-600) and 297ml (50-700), respectively, the transfusion rate was 0%, 5.6% and 15.6%, respectively, the narcotic analgesia requirement was 20mg, 15mg and 43mg of morphine sulfate, respectively, the post-operative hospital stay was 4.8 days, 5.2 days and 10.5 days respectively, and the number of complication was 1/16 cases (6.3%), 1/18 cases (5.6%) and 4/32 cases (12.5%) respectively. The surgical and pathological parameters of LRN showed no significant difference compared to those of the HALS. Conclusions: LRN for renal tumors was less invasive than ORN and it showed similar surgical results to HALS. Therefore standard laparoscopic radical nephrectomy is considered to be an effective and safe treatment modality for renal tumors.