ABSTRACT
The findings of contemporary single-institution series describing the most clinically significant experience with laparoscopic radical nephroureterectomy are listed in Table 1 and are stratified by type of laparoscopic approach. To date, no prospective randomized
tomy have been performed. Retrospective studies have found that operative times for the conventional approach are longer than are those for the hand-assisted approach, that blood loss, narcotic use, and hospitalization are equivalent for the two approaches, but that convalescence is longer in those undergoing hand-assisted laparoscopic radical nephroureterectomy (29). Laparoscopic nephrectomy has been found to cost 21% less than open and hand-assisted laparoscopic nephrectomy, a finding that is likely applicable to laparoscopic radical nephroureterectomy (30). A hand-assisted approach for laparoscopic radical nephroureterectomy may be cumbersome because the incision is often too high for adequate distal ureter and bladder dissection or too low for comfortable renal dissection, causing substantial ergonomic discomfort to the surgeon (27).
