New Technique for Removing Cancerous Kidneys

A study has found that allowing surgeons to remove cancerous kidneys by laparoscopy with the help of their hands is a more precise technique that enables them to handle major complications better and shortens time spent in the operating room. The study, conducted by researchers at the University of Michigan Health System (U-M, Ann Arbor, MI, USA; www.med.umich.edu), was presented at the annual meeting of the American Urological Association in Anaheim (CA, USA).

The study involved 38 patients who had a kidney removed laparoscopically between 1996 and 2000. Twenty-two had had a hand-assisted operation. In hand-assisted operations, the patient's abdomen is inflated by gas so that the surgeon can insert a hand through a small incision via a special pressurized sleeve. The researchers found that with both a hand and laparoscopic instruments doing the work, the surgeon has more control over the operation and more of a sense of depth and sensation than can be gained through the lens of a camera. Also, the kidney can be removed intact, making it easier to evaluate the cancer. The study results confirmed that hospital stay and pain were the same for both groups, and the length of the operation was shorter for those having the hand-assisted procedure.

U-M doctors are also using hand-assisted laparoscopy for removing living-donor kidneys for transplant. In the first-ever randomized clinical trial comparing open surgery to laparoscopic surgery, they found that patients who had the less-invasive operation used 47% less painkillers, that their hospital stays were 35% shorter, and that they have 73% less pain at six weeks past the operation. They also return to strenuous activity and work much sooner. However, the operation was longer and hospital costs were higher.

"Our study shows that hand-assisted laparoscopic nephrectomy can be done in significantly less time than the standard laparoscopic procedure, but that hand-assisted patients suffer no more complications and spend no more time in the hospital than the others,” said J. Stuart Wolf, Jr., M.D., U-M assistant professor of surgery and co-author of the study.




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