Complications of Hand-assisted Laparoscopic Renal Surgery: Single-center Ten-year Experience

• Published in: Urology (Ridgewood, N.J.) Vol. 77; no. 6; pp. 1353 - 1358
• Main Authors: Moore, Nathan W, Nakada, Stephen Y, Hedican, Sean P, Moon, Timothy D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2011; Elsevier
• Subjects: Age Factors; Aged; Biological and medical sciences; Female; Hand-Assisted Laparoscopy - adverse effects; Hand-Assisted Laparoscopy - methods; Humans; Kidney - surgery; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Nephrectomy - adverse effects; Nephrectomy - methods; Nephrology. Urinary tract diseases; Nephrons - pathology; Perioperative Period; Retrospective Studies; Risk Factors; Robotics; Steroids - therapeutic use; Urology; Endoscopic surgery; Center; Nephrology; Treatment; Urinary system; Laparoscopic surgery; Complication; Hand; Kidney; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2010.11.055

Objectives To review our perioperative complications during the first decade of using hand-assisted laparoscopic nephrectomy using a sleeve (HALN). HALN is a minimally invasive procedure first reported by our group in 1997. Methods After institutional review board approval, the charts of the patients who had undergone HALN, hand-assisted laparoscopic partial nephrectomy, or hand-assisted laparoscopic nephroureterectomy from 1997 to 2007, at our institution, were retrospectively reviewed. Standard laparoscopic procedures were not included. The relevant patient characteristics, operative details, American Society of Anesthesiologists score, body mass index, comorbidities, medications, and complications were recorded. Results A total of 227 consecutive patients had undergone Hand-assisted laparoscopic renal surgery, and all their charts were reviewed. Of these 227, 134 were radical HALN, 37 were nonradical HALN, 42 were hand-assisted laparoscopic partial nephrectomy, and 15 were hand-assisted laparoscopic nephroureterectomy. Complications developed in 59 patients (26%): 8% major and 18% minor. The procedure-specific complication rate was 29% for radical HALN, 27% for nonradical HALN, 33% for hand-assisted laparoscopic nephroureterectomy, and 17% for hand-assisted laparoscopic partial nephrectomy. Complications included blood transfusion in 6%, urinary retention in 4%, ileus in 4%, and wound infection in 4%. From 2003 through 2007 (n = 163), our overall complication rate was 22% (8% major and 13% minor). From 1997 to 2002 (n = 65), the overall complication rate was 38% ( P = .02). The American Society of Anesthesiologists score and the use of systemic steroids were associated with the occurrence of perioperative complications. Conclusions Our results have shown that hand assistance provides a safe, minimally invasive laparoscopic procedure. Our complications rates were comparable to those with other standard and hand-assist series, although the spectrum of complications varied. Hand-assisted laparoscopic renal surgery could be a method by which to improve patient access to minimally invasive nephron-sparing surgery.