Translation: Sorokin Konstantin Vladimirovich, Head of the Training Laboratory of the Russian Oncology Research Center Robert B. Nadler, Stacy Loeb, J. Quentin Clemens, Robert A. Butler, Chris M. Gonzalez, Itay Y. Vardi J Urol. 2006 Apr;175(4):1230-3; Objective: We performed a prospective, randomized clinical trial to compare three standard techniques of laparoscopic radical nephrectomy: transperitoneal, retroperitoneal, and hand-assisted. Materials and Methods: Thirty-three patients with solid renal lesions less than 7 cm were operated on using three techniques: hand-assisted, transperitoneal with morcellation, and retroperitoneal with intact lesion extraction. All operations were performed by a single surgeon. The three techniques were compared in terms of preoperative, intraoperative, and postoperative parameters. Results: Eleven patients were operated on using each technique. Age, American Society of Anesthesiologists classification, and body mass index did not differ significantly between the groups. Operative time was significantly shorter with manual assistance, while blood loss was similar in all three groups. Incision size, hospital stay, and return to normal activity were shortest with the transperitoneal approach. A slight trend toward less narcotic use was also observed with the transperitoneal approach. Manual assistance was associated with a higher rate of hernia formation.