title: Conventional and hand-assisted laparoscopic radical nephrectomy: Comparative analysis of 271 cases.
abstract: OBJECTIVE
  To compare the outcomes of patients undergoing conventional laparoscopic radical nephrectomy (CLRN) and hand-assisted laparoscopic radical nephrectomy (HALRN) at our institution.
  
  
  METHODS
  We prospectively and retrospectively reviewed the files of consecutive patients who underwent HALRN (N = 158 patients) from April 2001 to May 2005 and CLRN (N = 113) from August 2002 to May 2005 for clinical stage T(1-3)N(0-1)M(0-1) renal-cell carcinoma. Clinical and perioperative variables of the two groups were compared. Patients were well matched with regard to baseline parameters except that patients undergoing CLRN were 8 years older (P < 0.001) and had higher American Society of Anesthesiologists scores (P = 0.001).
  
  
  RESULTS
  Significantly different outcomes were faster operative time (P < 0.001), greater use of narcotic analgesia (P < 0.001), and longer hospitalization (P < 0.001) with HALRN. For the other variables analyzed, including blood loss, incision size, and complication rates, the two approaches were not significantly different.
  
  
  CONCLUSIONS
  Within the limitations of a retrospective study, HALRN was a faster operation than CLRN but was associated with greater use of narcotic analgesia and longer hospitalization. Overall, the similarities between these two approaches outnumber the differences, some of which may be explained by surgeon-specific practices. Both modalities offer patients excellent immediate cancer control while minimizing perioperative morbidity.
authors.affiliation: Department of Urology, The University of Texas M D Anderson Cancer Center, Houston, Texas 77030, USA. surmatin@mdanderson.org
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.forename: Nadeem
authors.initials: N
authors.lastname: Dhanani
authors.forename: Mirelis
authors.initials: M
authors.lastname: Acosta
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome