Experience With Handassisted Laparoscopy Simple Nephrectomy

There are logical benefits of performing inflammatory nephrectomies using handassisted laparoscopy because the normal anatomic planes are not often present. Simple nephrectomy is often not so simple.

The initial report of hand-assisted laparoscopy nephrectomy included a patient with a severely inflamed kidney and obstructed ureter and a chronic indwelling nephrostomy tube (4). The benefits of hand-assisted dissection are useful when tissues are firm, and cannot be easily dissected without tactile feedback (9). There have been formal reports of hand-assisted laparoscopy simple nephrectomy and the technique, highlighting these concepts (10,11).

Another procedure that can be improved by using hand-assisted laparoscopy is laparoscopic nephrectomy for autosomal dominant polycystic kidney disease.

Initially reported using standard laparoscopy by Elashry et al., this series offered the first alternative to open surgery, which had higher complication rates and prolonged convalescence compared to its laparoscopic counterpart (12). The main concerns with standard laparoscopy for these patients include the management of large specimens and lesion extraction. In addition, access to the abdomen can be complex because the abdomen is filled by cystic disease. Making the hand incision to start the case can be beneficial when performing these cases as closed entry risks injuring cysts and other structures.

Similarly, bilateral nephrectomies are well suited to hand-assisted laparoscopy. Bilateral nephrectomy for autosomal dominant polycystic kidney disease has been reported using a single midline incision (13,14). These rather complex operations could be performed in four to five hours. Typically, repositioning the patient is not necessary.

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