Hand-assisted radical nephrectomy study

Since the 1960's, radical nephrectomy through an open surgical approach has been the accepted standard of care for patients with localized and locally advanced renal cell carcinoma (RCC).

More recently, minimally invasive approaches with laparoscopy have become increasingly utilized in renal surgery, where oncologic outcomes have mirrored open surgical series to date. Hand assisted laparoscopic radical nephrectomy (HALRN), first described in 1994, has revolutionized the treatment of localized renal tumors. While critics argue that it is "laparoscopy with training wheels", HALRN has been increasingly utilized as a viable alternative to open surgery, particularly by surgeons not comfortable with the straight laparoscopic approach, with good outcomes. The literature regarding HALRN has suggested that it is equivalent in oncologic outcomes to open surgery, still maintains the benefits of minimally invasive approaches, and allows a method for intact specimen extraction. Here Kawauchi and colleagues report on their experience with HALRN for RCC.

The authors report on 123 patients who underwent HALRN, and compare them to 70 patients treated with an open surgical approach. They noted no difference in operative time, complications, or number of transfusions required. Estimated blood loss was significantly more for the open surgical patients (pless than 0.001). The disease free and cancer specific survival was not significantly different between the two groups, with a median follow-up of 41 months for the HALRN group and 74.5 months for the open surgical group. Importantly, the experience of the surgeon did not appear to influence outcome. Of the 25 surgeons included in the study, 23 had performed less than 10 HALRN cases, indicating that there is not a large learning curve that has been associated with the implementation of other laparoscopic procedures into practice. There were no port site recurrences reported in the laparoscopic group.

HALRN demonstrates equivalent oncologic outcomes when compared to open surgical approaches. While maintaining the benefits of minimally invasive approaches, the experience of the surgeon in performing the procedure does not appear to be as integral to outcome as it may be in other laparoscopic surgical procedures.