title: Hand-assisted laparoscopy for large renal specimens: a multi-institutional study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  HAL provides a safe, reproducible, and minimally invasive technique to remove large renal tumors and renal tumors in the obese.
authors.affiliation: Department of Urology, New York University Medical Center, New York, New York 10016, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stifelman
authors.forename: Toby
authors.initials: T
authors.lastname: Handler
authors.forename: Alan M
authors.initials: AM
authors.lastname: Nieder
authors.forename: Joseph
authors.initials: J
authors.lastname: Del Pizzo
authors.forename: Samir
authors.initials: S
authors.lastname: Taneja
authors.forename: R Ernest
authors.initials: RE
authors.lastname: Sosa
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Shichman
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D015897:Comorbidity; D003289:Convalescence; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009392:Nephrectomy / Q000379:methods*; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009294:Narcotics