Laparoscopic radical and partial nephrectomy.

Abstract

Laparoscopic nephrectomy has been an alternative to open surgery for benign renal disease since Clayman et al. published the first report of successful laparoscopic nephrectomy in 1991 [5]. Since then, institutions worldwide have published case reports and series of patients treated with laparoscopic simple nephrectomy, radical nephrectomy (LRN), nephroureterectomy, partial nephrectomy (LPN), and wedge resection (LWR) for both benign and malignant disease. The rationale behind performing laparoscopic renal surgery includes shorter hospital stays, less postoperative pain, and a more rapid return to normal activity. In addition, there may be favorable postoperative immune effects of laparoscopy, as compared to conventional surgery. Drawbacks of laparoscopic renal surgery include: longer operative times, a significant learning curve, and higher overall costs. While laparoscopic renal surgery quickly proved itself as a superior alternative to open surgery for benign disease, the question of the efficacy of laparoscopy for malignancy can only be answered by long-term follow-up. Thus far, laparoscopic radical nephrectomy, partial nephrectomy, and wedge resection have been performed over the last 9 years with encouraging results. These procedures continue to improve with advancing technique and technology and are rapidly being incorporated into the management of renal tumors. With the increased use of computed tomography and ultrasound, we can expect to face an ever increasing number of renal tumors. As these lesions are often discovered incidentally, patients will present with earlier clinical stages and confined disease amenable to laparoscopic extirpation. Nephron-sparing open renal surgery for smaller renal tumors (< 4 cm) has gained acceptance in the last 15 years. While the initial results for laparoscopic partial nephrectomy are limited, improvements in technology will facilitate its progress. This article evaluates the role of LRN and LPN in the management of renal tumors.