Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Upper urinary tract transitional cell carcinoma (UT-TCC) necessitates radical nephroureterectomy.
• Traditional open nephroureterectomy (ONU) involves significant morbidity.
• Hand-assisted laparoscopy offers a potential alternative for UT-TCC treatment.

Purpose of the Study:

• To evaluate the initial experience with hand-assisted retroperitoneoscopic nephroureterectomy (HARN) for UT-TCC.
• To compare the outcomes of HARN with a contemporary series of open nephroureterectomy (ONU).

Main Methods:

• A retrospective review of 34 consecutive patients undergoing HARN for UT-TCC.
• Comparison of HARN outcomes with 34 patients who underwent ONU.
• Ensuring intact specimen extraction in all cases.

Main Results:

• Operative times were similar between HARN and ONU (233 vs. 236 minutes).
• HARN demonstrated significantly less estimated blood loss (236 vs. 427 ml) and reduced postoperative analgesic requirements.
• HARN patients experienced shorter intervals to oral intake, ambulation, and hospital discharge, with similar complication rates (12%) and recurrence rates (12%) compared to ONU.

Conclusions:

• Hand-assisted retroperitoneoscopic nephroureterectomy is a viable and safe alternative to open surgery for UT-TCC.
• HARN offers significant advantages in terms of reduced blood loss and faster patient recovery.
• Further investigation into long-term outcomes of HARN for UT-TCC is warranted.