Examination of laparoscopic retrieval bag washings for malignant cells after hand-assisted laparoscopic radical nephrectomy and intact specimen removal

Objectives. Port site metastases after hand-assisted laparoscopic radical nephrectomy have been described in the literature. There is no uniform agreement among urologists regarding the use of a retrieval bag before intact specimen removal. The aim of this study was to determine whether LapSac renal extraction bag washings contain malignant cells. Methods. We prospectively obtained washings from the LapSac retrieval bag after hand-assisted laparoscopic radical nephrectomy and intact specimen removal for renal cell carcinoma. In 30 consecutive cases, after removal of the kidney specimen from the LapSac, the LapSac was irrigated with 50 mL sterile Hank's balanced salt solution. These washings were sent for cytologic examination. Cytologic evaluation was performed with a Thin Prep and the Papanicolaou method. Results. We performed 30 hand-assisted laparoscopic radical nephrectomies for suspected renal cell carcinoma with the above protocol. One specimen was benign and one showed transitional cell carcinoma; these were excluded from the study. Six specimens were stage T1a, 17 were T1b, 1 was T2, 2 were T3a, and 2 were T3b. Histopathology revealed 27 specimens with clear cell renal cell carcinomas with Fuhrman grades from 1 to 4; 1 specimen showed chromophobe renal cell carcinoma. Margins were negative in all cases, and there were no gross or microscopic tumor violations. The cytologic results from 27 cases were negative and in 1 case with T3b renal cell carcinoma the LapSac washings were positive for malignant cells. Conclusions. The preliminary findings from our study show that low-stage, low-grade tumors removed laparoscopically with minimal manipulation do not exfoliate cells into their LapSac retrieval bags.