title: Laparoscopic radical nephrectomy: incorporating advantages of hand assisted and standard laparoscopy.
abstract: OBJECTIVE
  We present an approach to laparoscopic radical nephrectomy and intact specimen extraction, which incorporates hand assisted and standard laparoscopic techniques.
  
  
  METHODS
  A refined approach to laparoscopic radical nephrectomy is described and our experience is reviewed. A low, muscle splitting Gibson incision is made just lateral to the rectus muscle and the hand port is inserted. A trocar is placed through the hand port and pneumoperitoneum is established. With the laparoscope in the hand port trocar 2 additional trocars are placed under direct vision. The laparoscope is then repositioned through the middle trocar and standard laparoscopic instruments are used through the other 2 trocars including the one in the hand port. If at any time during the procedure the surgeon believes the hand would be useful or needed, the trocar is removed from the hand port and the hand is inserted.
  
  
  RESULTS
  This approach has been applied to 7 patients. Mean estimated blood loss was 200 cc (range 50 to 300) and mean operative time was 276.7 minutes (range 247 to 360). Mean specimen weight was 767 gm. (range 538 to 1,170). Pathologically 6 specimens were renal cell carcinoma (grades 2 to 4) and 1 was oncocytoma. Mean length of hospital stay was 3.71 days (range 2 to 7). There were no major complications.
  
  
  CONCLUSIONS
  We believe that this approach enables the surgeon to incorporate the advantages of the hand assisted and standard laparoscopic approaches.
authors.affiliation: The Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Lee E
authors.initials: LE
authors.lastname: Ponsky
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cherullo
authors.forename: Kevin L W
authors.initials: KL
authors.lastname: Banks
authors.forename: Marc
authors.initials: M
authors.lastname: Greenstein
authors.forename: Stevan B
authors.initials: SB
authors.lastname: Streem
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: Craig D
authors.initials: CD
authors.lastname: Zippe
mesh_terms: D016063:Blood Loss, Surgical; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D009392:Nephrectomy / Q000379:methods*