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Laparoscopic kidney removal has many benefits: Hand-assisted procedure as effective as standard surgery

After reviewing about 100 cases they performed over the past four years, doctors at Mayo Clinic in Jacksonville say hand-assisted laparoscopic kidney removal appears to be as effective as the standard procedure in eradicating renal cancer. Benefits of the laparoscopic approach already include a smaller incision, less pain, a shorter hospital stay and shorter recovery time for the patient.

Tumors and an uncommon kidney cancer, called transitional cell cancer, are primary reasons for kidney removal (nephrectomy). Traditionally, surgeons removed diseased kidneys through an 8- to 10-inch incision from the middle of the abdomen to the back. The hand-assisted laparoscopic approach permits the surgeon to make two small abdominal incisions to insert the laparoscopic tools and another incision, about 3.5 inches long, for the surgeon's hand to help dissect and remove the kidney.

Dr. Michael Wehle says urologists were concerned initially that the hand-assisted approach, pioneered in the late 1990s, would not be as effective. "We're potentially doing more manipulation of the kidney and the tumor, so the question was, is there a chance one could spill tumor cells and contaminate sites where the instruments go in," the Mayo Clinic urologist says. "But that does not seem to be the case."

Hand-assisted laparoscopic nephrectomy gives the surgeon and the patient the best of both surgeries.

When surgeons began removing kidneys with laparoscopic instruments, they discovered limitations. They could free the kidney, but without the direct use of their hands and with an incision only big enough to insert instruments, the kidney had to be shredded with a special tool or the incision had to be enlarged. The procedure took longer than the traditional open one. Modifying the procedure to make room for a hand sped it up and gave surgeons the advantage of handling the kidney directly.

"The hand-assisted technique is the approach we prefer now," Wehle says, "because the hand is such a great surgical instrument to have at the very beginning. It shortens the surgery time. The hand acts as a retractor. It gives tactile information, which is lacking sometimes with the instruments. And the recovery time for the patient doesn't seem to be any greater than with a purely laparoscopic approach."

The hand-assisted approach is best suited to tumors 3 to 10 centimeters (about 1 to 4 inches) large. It can always be converted to the traditional surgery if a tumor proves too large to remove laparoscopically.

Drs. Todd Igel, Wehle and Paul Young have also used the hand-assisted laparoscopic approach for other kidney diseases and for partial nephrectomies — when tumors are fairly small or there is the need to preserve kidney function in the single remaining kidney.

"I can't say enough about the procedure. It's truly the way to go as far as pain," says Beverly Thompson.

She knows. Thompson had a kidney removed in 1994 with the traditional open approach. In 2001, Wehle removed part of her remaining kidney after an unrelated, second tumor was discovered. He used the hand-assisted laparoscopic approach.

"With the first procedure, the incision was much larger," Thompson says. "Recovery time was longer, and the discomfort was just incredible; there's no way to describe it."

In 1994, she spent seven days in the hospital, four of them in the intensive care unit. She missed about 10 weeks of work and only returned because she felt she had to, and then only part time. In 2001, she had half the hospital stay, could get herself out of the car when she went home and walk up a flight of stairs unassisted. She took eight weeks off from her job to recover and then returned to work full time. "I quite literally stepped back into my life at the end of that time as if nothing had happened," Thompson says.

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