[Hand-assisted laparoscopic nephrectomy in challenging cases].
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.
López Cubillana
P
P
Servicio de Urología, Hospital Virgen de la Arrixaca, Murcia, España.
Prieto González
A
A
Tornero Ruiz
J I
JI
López López
A I
AI
Cao Avellaneda
E
E
Server Pastor
G
G
Escudero
J F
JF
López González
P A
PA
Doñate
G
G
Ruiz Morcillo
J C
JC
Gómez Gómez
G
G
Pérez Albacete
M
M
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