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At least 19 recordsLinked to original sources
PubMed2002

Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy.

The benefits of laparoscopic living-donor nephrectomy (LDN) are well described, while similar data on hand-assisted laparoscopic living-donor nephrectomy (HALDN) are lacking. We compare hand-assisted laparoscopic living-donor nephrectomy with open donor nephrectomy. One hundred consecutive hand-assisted laparoscopic living-donor nephrectomy (10/98-8/01) donor/recipient pairs were compared to 50 open donor nephrectomy pairs (8/97-1/00). Mean donor weights were similar (179.6 +/- 40.8 vs. 167.4 +/- 30.3 lb; p = NS), while donor age was greater among hand-assisted laparoscopic living-donor nephrectomy (38.2 +/- 9.5 vs. 31.2 +/- 7.8 year; p < 0.01). Right nephrectomies was fewer in hand-assisted laparoscopic living-donor nephrectomy [17/100 (17%) vs. 22/50 (44%); p < 0.05]. Operative time for hand-assisted laparoscopic living-donor nephrectomy (3.9 +/- 0.7 vs. 2.9 +/- 0.5 h; p < 0.01) was longer; however, return to diet (6.9 +/- 2.8 vs. 25.6 +/- 6.1 h; p < 0.01), narcotics requirement (17.9 +/- 6.3 vs. 56.3 +/- 6.4h; p < 0.01) and length of stay (51.7 +/- 22.2 vs. 129.6 +/- 65.7 h; p < 0.01) were less than open donor nephrectomy. Costs were similar ($11072 vs. 10840). Graft function and 1-week Cr of 1.4 +/- 0.9 vs. 1.6 +/- 1.1 g/dL (p = NS) were similar. With the introduction of HALDN, our laparoscopic living-donor nephrectomy program has increased by 20%. Thus, similar to traditional laparoscopic donor nephrectomy, hand-assisted laparoscopic living-donor nephrectomy provides advantages over open donor nephrectomy without increasing costs.

Activities of Daily Living↗
PubMed2000

[Laparoscopic nephrectomy in geriatric patients: comparison with conventional nephrectomy].

INTRODUCTION: We report our experience with laparoscopic nephrectomy in comparison to open nephrectomy in geriatric patients. The laparoscopic technique is presented and the results are discussed with respect to the data from the current literature. MATERIAL AND METHODS: Since 1993, a total of 249 patient have undergone a nephrectomy for benign renal disease. In 131 patients a laparoscopic nephrectomy (in most cases via a transperitoneal approach) was performed and in 118 patients an open nephrectomy via a flank incision. Clinical parameters were compared between both groups as well as with respect to different age groups. RESULTS: There were no differences in terms of operative results (operative time, pre- and postoperative hemoglobin) between the laparoscopy group and open nephrectomy group as well as among the different age groups. Patients in the laparoscopy group demonstrated significant advantages with respect to blood loss, transfusion rate, analgesic consumption, hospital stay, and convalescence. These advantages were not related to patient age. The complication rate was comparable for both groups; however, both groups showed an elevation of the complication rate in the age groups 75 to 84 years. The mortality rate within the first 30 days after nephrectomy was 1.7% in the open nephrectomy group. CONCLUSIONS: The laparoscopic nephrectomy offers comparable operative results (with less blood loss and a lower transfusion rate) when compared to open nephrectomy. In terms of postoperative parameters, patients in the laparoscopy group have significant advantages. Especially geriatric patients benefit from these advantages and, therefore, the laparoscopic approach should be the preferred technique for a nephrectomy in these patients.

Aged↗
PubMed2005

A laparoscopic approach to allograft nephrectomy and bilateral native nephrectomy: a case report.

INTRODUCTION: Laparoscopic surgery is rapidly emerging as the standard of care for a variety of urological conditions, even among patients who have undergone prior renal transplantation. We describe the technique of bilateral native nephrectomy and allograft nephrectomy by laparoscopy. CASE REPORT: A 32-year-old man with end-stage renal disease who had undergone a cadaveric renal transplant presented with chronic graft dysfunction. He had received a living donor kidney transplant with a postoperative course complicated by persistent proteinuria and refractory hypertension. Our nephrology service indicated the need for bilateral native nephrectomy and allograft nephrectomy for better blood pressure control following a second transplant. Bilateral native nephrectomy was performed following the previous reported techniques for pure laparoscopic nephrectomy. Allograft nephrectomy started by dissection of the iliac vessels to identify the vascular anastomosis. The hilum of the transplanted kidney was accessed. The renal vessels were clipped and transected. The ureter was identified and clipped. All three kidneys were removed from the abdominal cavity through a 3-cm skin incision. RESULTS: The left nephrectomy took 25 minutes and the right nephrectomy, 40 minutes. The estimated blood loss was 300 mL and the total operative time was 210 minutes. The patient had an uneventful postoperative course and was discharged on the third postoperative day. CONCLUSIONS: We demonstrate the feasibility of laparoscopic allograft nephrectomy and bilateral native nephrectomy in a transplant recipient.

Adult↗
PubMed1998

Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy.

PURPOSE: We report our initial experience with hand assisted laparoscopic nephrectomy, and compare it to our results of standard laparoscopic nephrectomy. MATERIALS AND METHODS: The results of 21 hand assisted and standard laparoscopic nephrectomies (15 simple and 4 radical nephrectomies, and 2 nephroureterectomies) were reviewed. Hand assisted laparoscopic nephrectomy was performed with a hand placed intra-abdominally using the Pneumo Sleeve,* in addition to standard laparoscopic instruments manipulated through laparoscopic ports. Standard laparoscopic nephrectomy was performed using laparoscopic instruments alone. Perioperative data were recorded and questionnaires, including visual analog pain scales, were administered prospectively to 17 of 21 cases. RESULTS: The average operative time for 13 hand assisted laparoscopic nephrectomies was 240 minutes, which was significantly less than the 325-minute average for 8 standard laparoscopic nephrectomies (p = 0.04). Major complications tended to be more frequent in the standard group (38 versus 8%, p = 0.10). Hospital stay, return to normal activity and corrected 2-week abdominal/flank pain score in the hand assisted group (3.1 days, 14 days and 0.8, respectively) were not significantly different from the standard group (3.0 days, 10 days and 0.2, respectively). CONCLUSIONS: Compared to standard laparoscopic techniques, hand assistance appears to facilitate the operative speed and safety of laparoscopic nephrectomy without sacrificing the benefits of minimally invasive surgery. Hand assistance may make laparoscopic nephrectomy more appealing to urologists without advanced laparoscopic experience, may facilitate the laparoscopic management of demanding pathological conditions and is particularly useful when intact specimens are required. Hand assistance, by improving manipulative ability and tactile sense, is helpful for select cases of laparoscopic nephrectomy.

Adolescent↗
PubMed2006

Why we consistently use the left donor kidney in living related transplantation: initial experience of right laparoscopic donor nephrectomy and comparison with left nephrectomy.

OBJECTIVES: Laparoscopic donor nephrectomy has become the method of choice for removal of living donor kidneys. However, the majority of laparoscopic donor nephrectomy cases have been limited to the left side owing to technical difficulties and renal vessel length. This study described the technique and compared donor outcomes and graft function of right and left laparoscopic donor nephrectomy. MATERIALS AND METHODS: Among 25 patients, 6 consecutive donors underwent right laparoscopic donor nephrectomy from March 2002 to January 2005. They were compared to 19 patients with left laparoscopic donor nephrectomy. We compared operative times, warm ischemia times, serial creatinines, creatinine clearances, complications, and graft function. RESULTS: There was no significant difference in any metric. The operative times (303 min. vs 274 min., P > .05) and warm ischemia times (133 s vs 186 s, P > .05) were similar between right and left laparoscopic donor nephrectomy procedures. In left laparoscopic donor nephrectomy, 3 patients had transient brachial plexus neuropathies. No major complication occurred among patients undergoing right laparoscopic donor nephrectomy. This study demonstrated that both donor and recipient outcomes are similar for right and left laparoscopic donor nephrectomy. CONCLUSIONS: Consistent use of the left kidney has not affected clinical outcomes. With hand-assisted laparoscopy, the right laparoscopic donor nephrectomy is safe, providing excellent graft function.

Adult↗
PubMed1999

Hand-assisted laparoscopic donor nephrectomy versus standard laparoscopic donor nephrectomy: a comparison study in the canine model.

The aim of this study was to compare live donor nephrectomy by hand-assisted laparoscopy to standard laparoscopy in a canine model. Fourteen dogs underwent a left laparoscopic nephrectomy; a standard laparoscopic nephrectomy technique was utilized in seven dogs. In a second group of seven dogs, a hand-assisted laparoscopic technique was used with a Dexterity Pneumo Sleeve hand port. All nephrectomies were performed as "donor" nephrectomies, dividing the vessels last. Total blood loss, operative warm ischemia, time and organ retrieval times were assessed for each group. The average operative time was significantly shorter for hand-assisted laparoscopic donor nephrectomy (32 +/- 8 minutes vs. 61 +/- 8 minutes; p = .02) than for the standard technique. The average warm ischemia (86 +/- 24 seconds vs. 224 +/- 52 seconds; p = .03) and average organ delivery times (4 +/- 3 seconds vs. 45 +/- 9 seconds; p < .01) also were shorter using the hand-assisted laparoscopic technique. No significant differences in average blood loss were found between the two groups (9 +/- 2 cc vs. 6 +/- 1 cc; p = 0.16, NS). Good parenchymal, ureteral, and vascular preservation was achieved by both techniques. Hand-assisted laparoscopy permits shorter operating times and warm ischemia times than standard laparoscopy in a canine model of donor nephrectomy. Hand assistance makes donor laparoscopic nephrectomy technically easier and significantly quicker to perform. If hand-assisted laparoscopy donor nephrectomy is confirmed to be a rapid and safe technique for removing an intact organ, laparoscopic nephrectomy will be a more widely accepted technique among urologists who participate in living related donor kidney transplantation.

Animals↗
PubMed2005

A controlled sequential evaluation of open donor nephrectomy versus classical and modified laparoscopic donor nephrectomy: an update.

This study sought to determine the procedure of choice for kidney retrieval for transplantation by comparing open donor nephrectomy to laparoscopic donor nephrectomy and modified laparoscopic donor nephrectomy and by analyzing intraoperative donor and recipient graft function parameters. In this single-center, controlled, sequential analysis, 100 consecutive donor-recipient pairs were recruited, grouped according to surgical procedure, and operated upon between 1997 to 2004, as follows: group 1, open donor nephrectomy (n = 30), performed from 1997 to 2000; group 2, laparoscopic donor nephrectomy (n = 28), performed from 2000 to 2002; and group 3, modified laparoscopic donor nephrectomy (n = 42), performed from 2002 to 2004. Data were analyzed by type of operative procedure, graft function, length of hospital stay, and donor recovery time. Operative time was similar for all three surgical approaches. Warm ischemia times for open donor nephrectomy and modified laparoscopic donor nephrectomy were similar. Acute tubular necrosis occurred in 7% of patients in all groups. Donor recovery and lengths of hospital stay were significantly shorter for laparoscopic approaches. Donor complications were similar in numbers, differing only in complication type. Graft function and survival were similar for all three surgical approaches. We conclude that modified laparoscopic donor nephrectomy is the procedure of choice for living kidney retrieval.

Adult↗
PubMedDate not supplied

Laparoscopic nephrectomy is cost effective compared with open nephrectomy in a large county hospital.

BACKGROUND AND OBJECTIVES: To evaluate the experience with laparoscopic nephrectomy in a large county hospital and perform a cost comparison between uncomplicated open and laparoscopic nephrectomy. METHODS: Eleven consecutive patients who underwent an uncomplicated laparoscopic nephrectomy in a large county hospital were compared with 8 patients who underwent uncomplicated open nephrectomy during the same period. Patient charts and corresponding billing records were reviewed to determine overall hospitalization cost and individual cost components. RESULTS: No perioperative complications occurred in either the laparoscopic or open group, and no statistically significant differences existed between groups with regard to patient demographics or operative parameters. The overall operating room costs favored the open nephrectomy group by dollars 1070 (P=0.003). However, the overall cost of hospitalization, surgeon professional fees, duration of hospitalization, room and board costs, laboratory, and radiology costs, pharmacy costs, intravenous solution and infusion pump costs all significantly favored the laparoscopic patient group. The mean difference in overall hospital cost between laparoscopic and open nephrectomy was dollars 1211 in favor of laparoscopy (P=0.037). CONCLUSIONS: Our experience with laparoscopic nephrectomy in a large county hospital demonstrates a clear economic advantage in favor of the laparoscopic approach. Given limited funding for public hospitals and a clear patient benefit, laparoscopic nephrectomy should constitute first-line therapy when nephrectomy is indicated.

Cost-Benefit Analysis↗
PubMed1997

Functional advantages of laparoscopic live-donor nephrectomy compared with conventional open-donor nephrectomy.

Live-donor kidney transplants accounted for only 27% of all kidney transplants performed in the United States in 1995. Prolonged hospitalization, pain, extended convalescence, and related socioeconomic concerns associated with traditional open-donor nephrectomy surgery may discourage potential donors, contributing to a low percentage of live kidney donors. To remove such disincentives, the laparoscopic live-donor nephrectomy procedure was introduced. In this study, the post-discharge course of 10 laparoscopic nephrectomy donors was compared with that of 27 open nephrectomy donors over the same time period. Laparoscopic nephrectomy donors experienced significantly shorter hospitalizations, less pain, felt able to return to work and normal routines sooner, and needed significantly less assistance during the recuperation period than did open nephrectomy donors. The laparoscopic nephrectomy procedure may decrease many of the concerns of potential donors, thus making live kidney donation more attractive and increasing the kidney supply.

Activities of Daily Living↗
PubMed2003

Minimal incision living donor nephrectomy compared to the hand-assisted laparoscopic living donor nephrectomy.

BACKGROUND: There has been a surge of minimally invasive procedures for living donor nephrectomy. We compared our minimal incision living donor (MILD) nephrectomy to hand-assisted laparoscopic (HAL) living donor nephrectomy METHODS: We conducted a Medline search and compared our first 45 MILD nephrectomies to the data from the University of Michigan (UM), Tulane University (TU), and the University of Chicago (UC). RESULTS: The MILD incision was smaller than the cumulative incisions in the UM and UC groups (8.6, 11 and 10.4 cm, respectively). The operating times were similar in the UM and UC groups (209, 246, and 215 min, respectively). The UM and TU lengths of hospital stay (1.8 and 2.2 days) were shorter than those of the MILD and UC groups (2.5 and 2.8 days). CONCLUSIONS: MILD nephrectomy has results similar to those of HAL living donor nephrectomy. It allows the surgeon with a traditionally trained background to perform a safe, minimally invasive operation without laparoscopic technology.

Adult↗
PubMed2002

Laparoscopic nephrectomy for tuberculous nonfunctioning kidney: comparison with laparoscopic simple nephrectomy for other diseases.

OBJECTIVES: To summarize the results of our 31 consecutive laparoscopic nephrectomies for renal tuberculosis and compare them with 45 laparoscopic nephrectomies performed for other benign etiologies. We previously reported our initial successful experiences in expanding the role of laparoscopic surgery with the introduction of laparoscopic nephrectomy for renal tuberculosis. METHODS: Thirty-one laparoscopic nephrectomies for renal tuberculosis were performed between June 1996 and December 2001. The patients consisted of 11 men and 20 women with a mean age of 44.2 years (range 29 to 64). The control group consisted of 17 men and 28 women with a mean age of 48.6 years (range 17 to 60). The two groups were comparable with regard to demographic data. Statistical analyses were used to compare the two groups in terms of various parameters, including surgical time, blood loss, analgesic requirements, resumption of oral intake, and hospital stay. RESULTS: Laparoscopic nephrectomy was successful in 30 cases of the tuberculosis group and 44 cases of the control group. The two groups showed comparable perioperative and postoperative parameters, except for mean operative time, which, at 244 minutes for the tuberculosis group, was significantly greater than the 216 minutes for the control group (P <0.05). No significant intraoperative or postoperative complications were observed in either group. CONCLUSIONS: The results of this study indicate that laparoscopic nephrectomy for renal tuberculosis is a safe, effective, and less invasive treatment modality. Therefore, we suggest that the renal tuberculous nonfunctioning kidney should be approached initially using the laparoscopic approach.

Adult↗
PubMed1998

T cell hypofunctions and glomerular sclerotic and angiogenic changes found both in rats received unilateral nephrectomy plus transplantation of syngeneic mesenteric lymph nodes and in rats received unilateral nephrectomy plus splenectomy.

Five male and 7 female Lewis rats unilaterally nephrectomized at the ages of 44-46 days were transplanted with the mesenteric lymph nodes (MLN) obtained from syngeneic rats 4 months after the nephrectomy. In addition, 6 males received unilateral nephrectomy plus splenectomy at the age of 38 days. All of these rats were observed for 8.5 months after the nephrectomy. Flow cytometry analyses indicated that 17-32% of MLN lymphocytes and 4-20% of peripheral blood (PB) lymphocytes lost CD2 antigen in the unilaterally nephrectomized rats. Approximately 20% of PB and MLN lymphocytes had lost CD2 antigen in the males with combined splenectomy and nephrectomy, one of which died of severe infection. The survival rates of the MLN graft after 4.5 months were 100% in the 5 nephrectomized males and 14% in the 7 nephrectomized females. The CD2 antigen on immunologically activated T cells was up-regulated. Twenty-eight% lymphocytes of the survived MLN graft and 51% PB T cells of the 7 females with MLN graft rejection showed the CD2 up-regulation. It was shown immunohistochemically that not only CD2-positive (+) cells but also CD4+ cells were increased in the cortex of the survived MLN graft. The hepatocyte growth factor receptor gene, c-met gene, was shown to be present in lymphocytes. The c-met was considered to cooperate with the CD2. Interstitial mononuclear cell infiltrations with glomerulosclerosis were found in the remaining kidneys of the males with unilateral nephrectomy plus MLN grafts. Glomerular angiogenesis and accompanying endothelial cell apoptosis were demonstrated without mesangial cell proliferation in the males with unilateral nephrectomy plus splenectomy.

Animals↗
PubMed2004

[Hand-assisted laparoscopic radical nephrectomy vs. open nephrectomy in the treatment of clinically localized renal cell carcinoma. Comparative study].

INTRODUCTION: The description of the first laparoscopic nephrectomy made a revolution in the managing of the benign and malignant renal diseases. Hand-assisted laparoscopy (HAL) was developed with the aim of offering advantages to both patients and surgeons. The aim of the present work is to compare, in our experience, the results offered in the radical nephrectomy by HAL and open surgery, by analysis of surgical time, estimated blood loss during surgery and hospital stay. METHODS: Eleven Hand-assisted laparoscopic (HAL) radical nephrectomies and eight open radical nephrectomies were carried out at our institution during the same period (June 2001 to December 2002). All patients underwent computed tomography and were found to have a clinically localised functioning renal mass in all cases. The size of this renal mass was 4-7 cm (average 5.5 cm) in the HAL group and 4.5-15 cm (average 7.8 cm) in the open group. Patient age, body mass index, and American Society of Anaesthesiologists' score showed no significant difference between groups. RESULTS: The average surgical time in the HAL group was 156.72 minutes, the average blood loss during surgery was of 83.6 ml and the average hospital stay was of 3.09 days. Conversion to open surgery was not necessary in any patient. Average surgical time in the open surgery group was 178.25 minutes, the estimated blood loss during surgery was of 337.75 ml (p < 0.05) and the hospital stay was of 5.37 days (p < 0.05). The comparison of the means by two-tailed student's t test revealed significant differences in estimated blood loss and hospital stay, favoring HAL, and no significant differences in surgical time. CONCLUSIONS: HAL nephrectomy is feasible in almost all nephrectomies and is a safe, reproducible, and minimally invasive technique to perform extirpable renal surgery. HAL offer clear advantages over traditional open surgery, including decreased blood loss and hospital stay.

Carcinoma, Renal Cell↗
PubMed2001

Hand-assisted laparoscopic surgery (HALS) for live donor nephrectomy is more time- and cost-effective than standard laparoscopic nephrectomy.

BACKGROUND: Hand-assisted laparoscopy (HALS) was introduced to increase the safety of living donor nephrectomies. Herein we evaluate the first HALS living donor nephrectomies performed at our center. METHODS: Traditional laparoscopic nephrectomies (TLS) (n = 11) and HALS nephrectomies (n = 11) were included in the study. One patient from the TLS group was excluded because the operation was converted to open nephrectomy. We compared the operating times (OT) and warm ischemia times (WIT) for the two procedures and calculated the operating costs. RESULTS: Mean OT was 270 min in the TLS group and 197 min in the HALS group; thus, there was, a significant reduction of 27% with HALS. WIT was 297 sec for the TLS group and 214 sec for the HALS group, for a reduction of 28%. Costs were also lowered for HALS. CONCLUSION: In addition to shortening both OT and WIT, HALS enhances the safety margin of the procedure, especially during trocar placement. It is further helpful in preventing torsion of the kidney and controlling potential bleedings, as well as during vascular stapling and kidney removal.

Adult↗
PubMed1994

Laparoscopic nephrectomy, radical nephrectomy and adrenalectomy: Nagoya experience.

A total of 37 patients with various renal and adrenal diseases underwent laparoscopic nephrectomy, radical nephrectomy and adrenalectomy since July 1991. The underlying diseases included renal calculi, vesicoureteral reflux, ureteropelvic junction obstruction, ureteral stenosis, ectopic ureter, vascular disease, renal cell carcinoma and adrenal tumors. Twenty-nine kidneys (including 5 with renal cell carcinoma) and 5 adrenal glands were removed successfully. Three cases failed because of dense adhesion to the surrounding structures, hemorrhage from the renal vein and hemorrhage from the vena cava, respectively. Of the remaining 34 patients 3 required additional open laparotomy to control bleeding or remove lost calculi. Mean operating time was 265 minutes for nephrectomy, 383 minutes for radical nephrectomy and 199 minutes for adrenalectomy, and mean estimated blood loss was 455 ml., 430 ml. and 80 ml., respectively. Average hospital stay was 10 days for the 31 patients without open laparotomy and convalescence was completed by postoperative day 21. These results indicate that laparoscopic surgery for renal and adrenal disease is a feasible, minimally invasive procedure. In the case of laparoscopic radical nephrectomy, however, longterm followup is necessary to confirm the efficacy.

Adolescent↗
PubMed2001

Hand-assisted laparoscopic radical nephrectomy: comparison to open radical nephrectomy.

OBJECTIVES: Hand-assisted laparoscopic surgery is easier to learn than standard laparoscopy and simplifies intact specimen removal. We present our experience performing hand-assisted laparoscopic radical nephrectomy (HALRN) and compare it with contemporary open radical nephrectomy performed at our institution. METHODS: We performed 18 HALRNs for renal tumors ranging in size from 2 to 11 cm (average 4.5). Patients ranged in age from 40 to 83 years (average 62.9). All patients underwent HALRN with intact removal through a 7 to 8-cm vertical midline incision through an impermeable wound protector. Two or three working ports were used. We retrospectively compared our results with the results of 18 open radical nephrectomies performed during the same period, with the patients matched for age, body mass index, and American Society of Anesthesiologists' score. RESULTS: In the HALRN group, the average operating room time was 220.5 minutes, average length of stay 3.9 days, average time to return to normal activity 15.8 days, and average time to return to work 26.8 days. The median time to return to 100% normal was 28.0 days. No conversions or re-explorations were necessary in the HALRN series. The final pathologic examination revealed renal cell carcinoma in 15, oncocytoma in 1, angiomyolipoma in 1, and a complex cyst in 1. At a maximum of 48 months of follow-up (average 12.2), no recurrences were identified. Three deaths occurred in the series; 2 patients died with no evidence of disease and 1 patient died of metastatic disease (the nephrectomy was palliative). In the open group, the average operating room time was 117.8 minutes, average length of stay 5.1 days, average time to return to normal activity 23.5 days, and average time to return to work 52.2 days. The median time to return to 100% normal was 150 days, with 3 patients never returning to 100% normal. CONCLUSIONS: Our series demonstrated that HALRN is a safe, effective, minimally invasive option for treating renal cell carcinoma and provides a shorter hospital stay (P = 0.02), earlier return to work (P = 0.04), and earlier return to 100% normal (P = 0.0002) than open radical nephrectomy.

Adenoma, Oxyphilic↗
PubMed2002

Hand-assisted laparoscopic radical nephrectomy: comparison with transabdominal radical nephrectomy.

The purpose of this study was to investigate whether hand-assisted laparoscopic radical nephrectomy (HALN) has benefits over the traditional transabdominal radical nephrectomy. More specifically we focused on the use of the hand-assisted technique as a definitive oncologic procedure for renal cancers. This study is a retrospective nonrandomized study comparing 12 hand-assisted laparoscopic radical nephrectomies with 12 transabdominal radical nephrectomies. All patients included in the study had the preoperative diagnosis of renal mass. HALN population averaged 1.83 +/- 1.64 (mean +/- standard deviation) major comorbidities versus 1.08 +/- 0.8 open (P = 0.032). The HALN OR time averaged 103 +/- 32.8 versus 57 +/- 18.3 minutes open (P = 0.001). The estimated blood loss mean for HALN was 83 versus 318 cm3 open (P = 0.001). Length of stay for HALN was 4.9 +/- 2.2 versus 5.9 +/- 2.9 days (P = 0.35). Days to regular diet was 2.9 +/- 2.3 in HALN versus 3.5 +/- 2.11 open (P = 0.52). Days of intravenous pain medications were 1.8 +/- 0.72 HALN versus 3.0 +/- 1.28 open (P = 0.016). Postoperative complication rates for the two groups were identical: two of 12 (ileus and post-operative bleeding). Tumor size mean was 6.8 +/- 2.99 cm for HALN versus 4.2 +/- 1.29 cm open (P = 0.012). Tumor margins were negative for 12 of 12 in HALN versus 11 of 12 open. Selection bias (selecting ailing patients to the HALN cohort) diminished the statistical significance of our postoperative recovery data. It is likely that a prospectively randomized study with a larger population may prove the hand-assisted approach equal if not superior to the open technique. The use of HALN in patients with renal tumors is an effective alternative to traditional transabdominal radical nephrectomy.

Aged↗
PubMed1977

Granularity of cells in the juxtaglomerular apparatus in fetal rats after maternal nephrectomy or fetal unilateral nephrectomy.

Granular cell indices (GCI: Dunihue and Robertson, '57) in kidneys of fetal rats one day after maternal nephrectomy of fetal unilateral nephrectomy on day 21 of gestation were determined by examining sections stained with Bowie's technique. Maternal nephrectomy induced an extreme increase of GCI in fetal kidneys with increased granularity of cells in the juxtaglomerular apparatus. Fetal unilateral nephrectomy did not cause any significant change.

Animals↗