Laparoscopic nephrectomy: assessment of morcellation versus intact specimen extraction on postoperative status.
OBJECTIVE
We compared pathological evaluation and postoperative recovery in patients undergoing transperitoneal laparoscopic nephrectomy at our institution with morcellated vs intact specimen extraction.


METHODS
A prospective evaluation of 57 consecutive patients undergoing radical and simple transperitoneal laparoscopic nephrectomy was reviewed. One patient was excluded from study due to transitional cell carcinoma, which was detected intraoperatively. The 33 morcellated specimens were extracted at the umbilical port and the 23 intact specimens were extracted through a midline infraumbilical incision. Data were obtained on narcotic requirements, hospital stay, complications, estimated blood loss, mass size based on preoperative imaging, specimen weight and extraction incision length.


RESULTS
Mean incision length in the morcellated and intact specimen removal groups was 1.2 and 7.1 cm, respectively (p <0.001). No significant differences in pain or recovery were noted between the 2 groups. Two cases of microscopic invasion of the perinephric adipose tissue in the intact specimen group were up staged from clinical T1 to pT3a disease. No change in patient treatment was made based on this information.


CONCLUSIONS
We did not find a significant difference in surgical time, pain or hospital stay. Only incision length was statistically significant. Postoperative recovery appeared to be similar in these 2 groups. With modern imaging modalities information on pathological stage did not alter patient treatment.
Hernandez
Fernando
F
Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Rha
Koon H
KH
Pinto
Peter A
PA
Kim
Fernando J
FJ
Klicos
Nicholas
N
Chan
Theresa Y
TY
Kavoussi
Louis  R
L
Jarrett
Thomas W
TW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies