a prospective study of laparoscopic radical nephrectomy for t1 tumors—is transperitoneal, retroperitoneal or hand assisted the best approach：一个腹腔镜肾癌根治术的前瞻性研究是t1肿瘤腹膜，腹膜后或手助的最好方法.pdfVIP

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a prospective study of laparoscopic radical nephrectomy for t1 tumors—is transperitoneal, retroperitoneal or hand assisted the best approach：一个腹腔镜肾癌根治术的前瞻性研究是t1肿瘤腹膜，腹膜后或手助的最好方法.pdf

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a prospective study of laparoscopic radical nephrectomy for t1 tumors—is transperitoneal, retroperitoneal or hand assisted the best approach：一个腹腔镜肾癌根治术的前瞻性研究是t1肿瘤腹膜，腹膜后或手助的最好方法

A Prospective Study of Laparoscopic Radical Nephrectomy for T1 Tumors—Is Transperitoneal, Retroperitoneal or Hand Assisted the Best Approach? Robert B. Nadler,* Stacy Loeb, J. Quentin Clemens, Robert A. Batler, Chris M. Gonzalez and Itay Y. Vardi From the Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois Purpose: We designed a prospective, randomized clinical trial to compare 3 common approaches to laparoscopic radical nephrectomy, namely transperitoneal, retroperitoneal and hand assisted. Materials and Methods: A total of 33 patients with a solid renal mass of 7 cm or less were prospectively enrolled in alternating fashion to a hand assisted procedure, a transperitoneal procedure with morcellation and a retroperitoneal procedure with intact specimen extraction. A single surgeon performed all operations. Preoperative, intraoperative and postoperative criteria were compared among the 3 techniques. Results: A total of 11 patients underwent each type of procedure. There was no signiﬁcant difference in age, American Society of Anesthesiologists class, body mass index or tumor size among the groups. Mean operative time was signiﬁcantly lower using the hand assisted approach, whereas estimated blood loss was similar in all 3 groups. Incision size, hospital stay and time to normal daily activity were less using the transperitoneal approach. While not signiﬁcant, there was a trend toward less narcotic use in the transperitoneal group. Hernia formation was seen with increased frequency in the hand assisted group. Conclusions: In our series the hand assisted approach had signiﬁcantly shorter operative time than the transperitoneal or retroperitoneal approach but it had the greatest risk of hernia formation. The transperitoneal approach was associated with a signiﬁcantly shorter hospital stay and the earliest