Hand-assisted laparoscopic kidney removal as effective as standard procedure

Friday, June 21, 2002

JACKSONVILLE, Fla., June 21, 2002 — After reviewing about 50 cases they performed over the past three 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 to kidney removal already include a smaller incision, 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- to10-inch long incision from the middle of the abdomen to the spine. 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 remove the kidney.

Dr. Michael Wehle, a Mayo Clinic urologist who performs both the hand-assisted and traditional nephrectomy, says urologists were concerned initially that the hand-assisted approach, pioneered in the late 1990s, would not be as effective. "People worried about the laparoscopic approach," he says. "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. 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 before it could be removed. The procedure took longer than the traditional open one, and surgeons had to make a 4- or 5-inch incision anyway to remove large tumors.

Wehle says surgeons modified the procedure by making an incision at the start large enough for their hand to work inside the abdomen in tandem with laparoscopic instruments. That modification sped up the procedure and gave surgeons the advantage of being able to directly handle the kidney.

"That's the approach we prefer now," Wehle says, "because the hand is such a great surgical instrument to have at the very beginning. It speeds the case up. It 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."

A quicker recovery is the main reason patients like Toni Dutton choose hand-assisted laparoscopic nephrectomy when given the choice. "If they had done it the old way, I would have had to resign my position," Dutton says. "I had just received a teaching position, and I believe I would have had to resign."

In September 2000, Dutton and her baby were in a car accident. Dutton's 7 month-old daughter suffered no injuries, but Dutton was taken to an emergency room and treated for broken bones, lacerations and a concussion. Suspecting internal injuries, doctors ordered a CT scan. They found no injuries, but were surprised to find a fist-sized kidney tumor in the then 33-year-old. "I was shocked to say the least, and said, 'No that's not why I'm in here,'" Dutton recalls. Dutton's urologist thought the tumor was cancerous and urged her to have the kidney removed immediately.

After the urologist explained the open procedure to her, Dutton and her husband sought another opinion. "We did some research on the computer and decided that Dr. Wehle was the one we wanted to see," Dutton says. "Dr, Wehle said there was a new procedure that he would try. He wasn't sure if he could with such a large tumor, but that he would go ahead and try it, and if that didn't work, he would have to do it the traditional way."

Wehle was able to remove the tumor with the hand-assisted laparoscopic approach. Dutton was in the hospital for three days after her nephrectomy. She missed little more than a month of school and says it took about three to four weeks for her to feel comfortable moving around and lifting things.

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

Mayo Clinic urologists have also used the hand-assisted laparoscopic approach for other kidney diseases and for partial nephrectomies ¾ 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 September 2001, Wehle removed part of her remaining kidney after an unrelated, second tumor was discovered. He used the hand-assisted laparoscopic approach, and Thompson says there's no comparing the two procedures. "With the first procedure, the incision was much larger. Recovery time was longer, and the discomfort was just incredible; there's no way to describe it," she says.

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.

A person normally has two kidneys, one on each side of the spine at the back just above the waist. Each is about the size of a small, adult fist. Together they cleanse and purify about 425 gallons of blood a day through 2 million tiny filters called nephrons. They also regulate blood volume; recycle water, minerals and nutrients; and make sure the blood has the correct chemical composition.

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Media contact: Erik Kaldor (904) 953-7347

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