title: [Hand-assisted laparoscopic nephrectomy in challenging cases].
abstract: OBJECTIVE
  To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors.
  
  
  METHODS
  A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled.
  
  
  RESULTS
  Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates.
authors.affiliation: Servicio de Urología, Hospital Virgen de la Arrixaca, Murcia, España.
authors.forename: P
authors.initials: P
authors.lastname: López Cubillana
authors.forename: A
authors.initials: A
authors.lastname: Prieto González
authors.forename: J I
authors.initials: JI
authors.lastname: Tornero Ruiz
authors.forename: A I
authors.initials: AI
authors.lastname: López López
authors.forename: E
authors.initials: E
authors.lastname: Cao Avellaneda
authors.forename: G
authors.initials: G
authors.lastname: Server Pastor
authors.forename: J F
authors.initials: JF
authors.lastname: Escudero
authors.forename: P A
authors.initials: PA
authors.lastname: López González
authors.forename: G
authors.initials: G
authors.lastname: Doñate
authors.forename: J C
authors.initials: JC
authors.lastname: Ruiz Morcillo
authors.forename: G
authors.initials: G
authors.lastname: Gómez Gómez
authors.forename: M
authors.initials: M
authors.lastname: Pérez Albacete
mesh_terms: D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D007669:Kidney Calculi / Q000150:complications; D007680:Kidney Neoplasms / Q000098:blood supply / Q000150:complications / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D009393:Nephritis / Q000150:complications; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D012082:Renal Veins; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology