Laparoscopic Renal Ablation

Abstract

Nephron sparing surgery (NSS) is accepted as the treatment of choice in patients with solitary kidney, bilateral renal masses, and in patients with renal insufficiency (1,2). In patients with renal tumors less than 4 cm and a normal contralateral kidney, NSS has been shown to have a decreased incidence of long-term renal insufficiency (2). It has also been associated with an improved quality of life (3,4). Open partial nephrectomy (OPN) is the gold standard treatment for NSS. Laparoscopic partial nephrectomy (LPN) has recently been popularized by Gill and associates (5). Although LPN has been shown to have good oncologic outcomes at an intermediate follow-up (6); it requires advanced laparoscopic skills and has associated perioperative morbidity (7,8). A recent large multicenter retrospective study compared the perioperative outcomes between open and laparoscopic partial nephrectomy (9). LPN was associated with shorter operative time, decreased operative blood loss, and shorter hospital stay. Although, the incidence of intraoperative complications was comparable in the two groups LPN was associated with longer ischemia time, more postoperative complications (particularly urological), and an increased number of subsequent procedures. Overall 25.2% of patients undergoing LPN had a postoperative complication compared to 19.8% who underwent OPN. After 3 months, renal functional outcomes for laparoscopic and open partial nephrectomy were similar.