Laparoscopic radical nephrectomy with morcellation for renal cell carcinoma: the Saskatoon experience.

OBJECTIVES: To assess safety and effectiveness of laparoscopic radical nephrectomy with specimen entrapment and morcellation in patients with suspected renal cell carcinoma.

METHODS: We reviewed 72 patients with solid tumors who were offered an attempt at laparoscopic radical nephrectomy.

RESULTS: Of 72 patients approached laparoscopically, 6 were converted to open nephrectomy. In the remaining 66 patients with tumor size on computed tomography scan ranging from 1.0 to 9.0 cm (average 4.5 cm), the nephrectomy was completed laparoscopically and the specimen morcellated for extraction. Eight patients were clinical Stage T1N0M0, 60 were T2N0M0, 3 were T3N0M0, and 1 was T2N0M1. There was one unexplained death but complications otherwise were minimal. Operating time ranged from 1 hour 40 minutes to 4 hours 52 minutes (average 2 hours 55 minutes). The average length of stay was 4.4 days (range 3 to 7 days) for the laparoscopic group. The average specimen weight was 402.5 g (range 115 to 964). Review of histologic findings revealed renal cell carcinoma in 57 patients, benign tumors in 6, and no diagnosis in 3. Follow-up on the malignancies ranges from 1.5 to 58 months (average 21.4), with no port site recurrences and no known disease progression.

CONCLUSIONS: At an average follow-up of 21.4 months, laparoscopic radical nephrectomy with specimen entrapment and morcellation appears to be a safe and effective alternative to conventional open radical nephrectomy for renal malignancy.