Hand-assisted laparoscopy for large renal specimens: a multi-institutional study

Stifelman, Michael D; Handler, Toby; Nieder, Alan M; Del Pizzo, Joseph; Taneja, Samir; Sosa, R.Ernest; Shichman, Steven J

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Volume 61, Issue 1 , Pages 78-82, January 2003

Hand-assisted laparoscopy for large renal specimens: a multi-institutional study

Michael D Stifelman
- Department of Urology, New York University Medical Center, New York, New York, USA
- Reprint requests: Michael Stifelman, M.D., Department of Urology, New York University School of Medicine, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA
Toby Handler
- Department of Urology, New York University Medical Center, New York, New York, USA
Alan M Nieder
- Department of Urology, New York University Medical Center, New York, New York, USA
Joseph Del Pizzo
- Department of Urology, New York Presbyterian Medical Center–Cornell Campus, New York, New York, USA
Samir Taneja
- Department of Urology, New York University Medical Center, New York, New York, USA
R.Ernest Sosa
- Department of Urology, New York Presbyterian Medical Center–Cornell Campus, New York, New York, USA
Steven J Shichman
- Department of Urology, Hartford Hospital, Hartford, Connecticut, USA

Received 26 April 2002; accepted 4 September 2002.

Abstract

Objectives

To present our experience with hand-assisted laparoscopy (HAL) for larger renal specimens. One of the theoretical benefits of HAL is the ability to manage large renal specimens, which we defined as tumors greater than 7 cm, and tumors in obese patients.

Methods

Between March 1998 and October 2000, 106 HAL radical nephrectomies were performed for enhancing renal masses, for which 95 patients had complete preoperative, intraoperative, and postoperative data. Of the 95 patients, 32 underwent HAL for large tumors (7 cm or greater) and 41 had a body mass index of 31 or greater. The demographic and outcome data of these two groups were compared with 63 patients who underwent HAL for tumors less than 7 cm and 54 patients with a body mass index of less than 31.

Results

When comparing cohorts by tumor size, the only statistically significant differences were in convalescence and specimen weight. Patients with lesions 7 cm or greater required 21 days to recover compared with 18 days for patients with lesions less than 7 cm. Obese patients had statistically significantly higher American Society of Anesthesiologists classifications, longer operative times (214 versus 176 minutes), and longer convalescences (21 versus 17.5 days) compared with nonobese patients. The estimated blood loss and conversion rate was not different between the groups. Furthermore, no difference was noted between the groups in the incidence of positive margins, local recurrence, or metastatic recurrence at a mean follow-up of 12.2 months.