Hand-Assisted and Total Laparoscopic Nephrectomy: a Comparison

BACKGROUND AND OBJECTIVES Debate continues as to the merits of hand-assisted versus pure laparoscopic nephrectomy. Using evidence-based analysis, we compared the outcomes of both. METHODS We performed a systematic review and metaanalysis of studies directly comparing hand-assisted with pure laparoscopic nephrectomy. We searched PubMed, the OVID database (from 1980), the Biosis previews ISI Web of Knowledge (1926-2007), and abstracts from annual meetings of the American Urological Association (2002-2007). Primary outcomes were operative blood loss, operative time, hospital length of stay, perioperative transfusions, and perioperative complications. We estimated standardized mean differences and risk ratios using the random effects models. RESULTS Twenty-five studies (N=3051) met the inclusion criteria. Hand-assisted nephrectomy was associated with significantly less operative blood loss and decreased risk of conversion. There were no significant differences in mean operative time, length of stay, or risks of perioperative transfusion or complication. CONCLUSIONS In this analysis, hand-assisted nephrectomy was associated with significantly less operative blood loss and risk of open conversion than was pure laparoscopic nephrectomy. The clinical significance of these findings is unclear; however, the pure and hand-assisted techniques appear to result in generally similar perioperative outcomes.