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The role of hand assisted laparoscopic nephrectomy
Author(s) -
MARTINDALE A.,
APPANNA T.C.,
GOAD J.,
TEMELCOS C.,
CLARKE A.,
ASOPA R.,
CLEEVE L.,
NIALL O.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06085_50.x
Subject(s) - medicine , nephrectomy , laparoscopy , surgery , general surgery , port (circuit theory) , demographics , abdomen , kidney , demography , sociology , electrical engineering , engineering
Objectives: We have been performing laparoscopic nephrectomies since 2002 and have used the hand assisted technique on a regular basis. We aim to report our results and to comment on the use of the hand port. Patients and Methods: A combination of retrospective and prospective data collection was used to obtain patient demographics, operative details, pathology information and outcome data for all patients who underwent laparoscopic nephrectomy between April 2002 and June 2005 at St. Vincent's Hospital and the Melbourne Urology Group in Melbourne. Results: We performed 78 laparoscopic nephrectomies, 47 of which were hand assisted in the specified time period on patients with a mean age of 63.4 years. 38% of the public patients were operated on by a non‐consultant as the primary surgeon and the median operating time was 180 min. No differences were observed between pure and hand assisted laparoscopy (HAL) in terms of patient recovery, morbidity, in patient stay and analgesic use. Conclusions: We have found the hand port to be a safe and effective tool for nephrectomy without the inherent risks of pure laparoscopy. As an incision is required to remove the kidney from the abdomen it seems illogical not to utilise that incision from the beginning of the case. The benefits are safer port placement, tactile feedback and early control of heavy bleeding. We would therefore advocate its use in all extirpative renal surgery.