title: Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma.
abstract: OBJECTIVE
  We report our experience with hand-assisted laparoscopic nephroureterectomy (HALN) for upper urinary tract transitional cell carcinoma and compare our results with a contemporary series of open nephroureterectomy (ON) performed at our institution.
  
  
  METHODS
  Between August 1996 and May 2003, 90 patients underwent nephroureterectomy for upper-tract transitional cell carcinoma (TCC). Thirty-eight patients underwent HALN, while 52 had an ON. End-points of comparison included operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of hospital stay, pathologic grade and stage of tumor, and tumor recurrence.
  
  
  RESULTS
  The mean patient age was 72.3 and 70.6 years in the ON and HALN groups, respectively. Mean operative duration was 243 minutes (ON) and 244 minutes (HALN), with an EBL of 478mL in the open group versus 191 mL in the hand-assisted group (P<0.001). No intraoperative complications occurred, but postoperative complications occurred in 4% and 11% of the ON and HALN groups, respectively (P=0.21). The mean hospital duration was 7.1 days (ON) versus 4.6 days (HALN) (P<0.01). No difference existed in the pathologic grade or stage distribution of urothelial tumors between the 2 groups. The mean follow-up was 51.0 months in the ON group and 31.7 months in the HALN group. Recurrence of urothelial carcinoma occurred in 50% of patients who underwent ON and 40% treated by HALN (P=0.38) at a median interval of 9.1 and 7.7 months, respectively, after surgery.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic nephroureterectomy is an effective modality for the treatment of upper urinary tract urothelial carcinoma. Patients benefited from less intraoperative blood loss and a shorter hospitalization with an equivalent intermediate-term oncologic outcome compared with that of the open approach.
authors.affiliation: Department of Urology, The New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021, USA. jay_d_raman@yahoo.com
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Michael A
authors.initials: MA
authors.lastname: Palese
authors.forename: Casey K
authors.initials: CK
authors.lastname: Ng
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Del Pizzo
authors.forename: R Ernest
authors.initials: RE
authors.lastname: Sosa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D018666:Ureteroscopy; D014571:Urologic Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*