Comparison of Gas-less laparoscopy-assisted surgery, hand-assisted laparoscopic surgery and pure laparoscopic surgery for radical nephrectomy.
BACKGROUND
We report our experience with Gas-less laparoscopy-assisted surgery (Gas-less LAS), hand-assisted laparoscopic surgery (HALS) and pure laparoscopic surgery (LS) for renal carcinoma and compare the characteristics and usefulness of these methods.


METHODS
Seventeen, 14 and 16 patients were subjected to Gas-less LAS, HALS and LS, respectively. The study started with Gas-less LAS and then gradually shifted to HALS and LS. We evaluated the operative and postoperative parameters for each group. The learning curve effect was evaluated based on data from the first 10 cases of each group, which were operated on by the same surgeon and operation team.


RESULTS
The learning curve of operation times in the LS group demonstrated that the operation time for this procedure is acceptable even in early-stage cases. Differences in mean operative time between the three surgical groups, excluding the conversion cases, were not statistically significant; however, there was a significant difference in blood loss volume between the groups (P </= 0.001). Operation time tended to be shorter in Gas-less LAS and the frequency of parental analgesia administration tended to be reduced in the LS group when compared to the other two groups. Of the total 47 patients treated, two cases were converted to open surgery. The major postoperative complication was one case of brain infarction in the HALS group. One patient in the LS group developed a lung metastasis 11 months after the operation.


CONCLUSIONS
As minimally invasive operative techniques, these three methods do not differ significantly in terms of surgical outcome; however, LS tended to be slightly superior in terms of postoperative pain control and cosmetic appearance.
Hayakawa
Kunihiro
K
Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Chiba, Japan. hayakawa@tdc.ac.jp
Aoyagi
Telichiro
T
Ohashi
Masakazu
M
Hata
Makoto
M
D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*