Skip to main content
SpringerLink
Log in

Laparoscopic partial nephrectomy and minimally invasive nephronsparing surgery

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Surgical extirpation remains the most effective therapy for renal cell carcinoma. The surgical management of renal masses has evolved away from radical nephrectomy and now includes nephron-sparing surgery for small tumors. Nephron-sparing surgery has similar cure rates and does not appear to compromise cancer control. As the detection of small renal masses by widespread abdominal imaging continues to increase, so will the demand for minimally invasive nephron-sparing procedures. Despite progress in surgical techniques, laparoscopic partial nephrectomy remains a technically challenging procedure. In this review, we discuss the challenges and recent advances in laparoscopic partial nephrectomy and other minimally invasive approaches to renal masses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Fyfe G, Fisher RI, Rosenberg SA, et al.: Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. J Clin Oncol 1995, 13:688–696.

    PubMed  CAS  Google Scholar 

  2. Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol 1969, 101:297–301.

    PubMed  CAS  Google Scholar 

  3. Butler B, Novick AC, Miller DP, et al.: Management of small unilateral renal cell carcinomas: radical versus nephronsparing surgery. Urology 1995, 45:34–40.

    Article  PubMed  CAS  Google Scholar 

  4. Morgan W, Zincke H: Progression and survival after renalconserving surgery for renal cell carcinoma: experience in 104 patients and extended follow-up. J Urol 1990, 144:852–857.

    PubMed  CAS  Google Scholar 

  5. Licht M, Novick A: Nephron sparing surgery for renal cell carcinoma. J Urol 1993, 149:1–7.

    PubMed  CAS  Google Scholar 

  6. Herr H: Partial nephrectomy for unilateral renal cell carcinoma and a normal contralateral kidney: 10-year followup. J Urol 1999, 161:33–34.

    Article  PubMed  CAS  Google Scholar 

  7. Clayman RV, Kavoussi LR, Soper NJ, et al.: Laparoscopic nephrectomy: initial case report. J Urol 1991, 146:278–282.

    PubMed  CAS  Google Scholar 

  8. Chan DY, Cadeddu JA, Jarrett TW, et al.: Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol 2001, 166:2095–2099.

    Article  PubMed  CAS  Google Scholar 

  9. Portis AJ, Yan Y, Landman J, et al.: Long-term follow-up after laparoscopic radical nephrectomy. J Urol 2002, 167:1257–1262.

    Article  PubMed  Google Scholar 

  10. Winfield H, Donovan JF, Godet AS, Clayman RV: Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 1993, 6:521–526.

    Google Scholar 

  11. Gill IS, Delworth MG, Munch LC: Laparoscopic retroperitoneal partial nephrectomy. J Urol 1994, 152:1539–1542.

    PubMed  CAS  Google Scholar 

  12. McDougall E, Clayman R, Anderson K: Laparoscopic wedge resection of a renal tumor: initial experience. J Laparoendosc Surg 1993, 3:577–581.

    PubMed  CAS  Google Scholar 

  13. Gill IS, Desai MM, Kaouk JH, et al.: Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 2002, 167:469–476. Fifty patients underwent LPN designed to recapitulate open techniques. No patients required conversion to an open procedure, and there were minimal complications.

    Article  PubMed  Google Scholar 

  14. McDougall E, Clayman R, Elashry O: Laparoscopic radical nephrectomy for renal tumor: the Washington University experience. J Urol 1996, 155:1180–1185.

    Article  PubMed  CAS  Google Scholar 

  15. Ward J: Determination of the optimum temperature for regional renal hypothermia during temporary renal ischemia. Br J Urol 1975, 47:17–24.

    PubMed  CAS  Google Scholar 

  16. Novick A: Renal hypothermia: in vivo and ex vivo. Urol Clin North Am 1983, 10:637–644.

    PubMed  CAS  Google Scholar 

  17. Gill IS, Munch LC, Clayman RV, et al.: A new renal tourniquet for open and laparoscopic partial nephrectomy. J Urol 1995, 154:1113–1116.

    Article  PubMed  CAS  Google Scholar 

  18. Elashry O, Wolf JS Jr, Rayala HJ, et al.: Recent advances in laparoscopic partial nephrectomy: comparative study of electrosurgical snare electrode and ultrasound dissection. J Endourol 1997, 11:15–22.

    PubMed  CAS  Google Scholar 

  19. Cadeddu JA, Corwin TS, Traxler O, et al.: Cable tie compression to facilitate laparoscopic partial nephrectomy. J Urol 2001, 219:177–178.

    Article  Google Scholar 

  20. Stifelman M, Sosa RE, Nakada SY, Shichman SJ: Hand-assisted laparoscopic partial nephrectomy. J Endourol 2001, 15:161–164.

    Article  PubMed  CAS  Google Scholar 

  21. Jackman S, Cadeddu JA, Chen RN, et al.: Utility of the harmonic scalpel for laparoscopic partial nephrectomy. J Endourol 1998, 12:441–444.

    PubMed  CAS  Google Scholar 

  22. Janetschek G, Daffer G, Peschel R, Bartsch G: Laparoscopic nephron sparing surgery for small renal cell carcinoma. J Urol 1998, 159:1152–1155.

    Article  PubMed  CAS  Google Scholar 

  23. Shekarriz H: Hydro-Jet assisted laparoscopic partial nephrectomy: initial experience in a porcine model. J Urol 2000, 163:1005–1008.

    Article  PubMed  CAS  Google Scholar 

  24. Itoh K, Suzuki Y, Miuru M, et al.: Posterior retroperitoneoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors. J Endourol 2002, 16:367–371.

    Article  PubMed  Google Scholar 

  25. Murota T, Kawakita M, Oguchi N, et al.: Retroperitoneoscopic partial nephrectomy using microwave coagulation for small renal tumors. Eur Urol 2002, 41:540–545.

    Article  PubMed  Google Scholar 

  26. Gettmann MT, Bishoff JT, Su LM, et al.: Hemostatic laparoscopic partial nephrectomy: initial experience with radiofrequency coagulation-assisted technique. Urology 2001, 58:8–11.

    Article  Google Scholar 

  27. Corwin TS, Caddeddu JA: Radiofrequency coagulation to facilitate laparoscopic partial nephrectomy. J Urol 2001, 165:175–176.

    Article  PubMed  CAS  Google Scholar 

  28. Pantuck A, Zisman A, Belldegrun A: The changing natural history of renal cell carcinoma. J Urol 2001, 166:1611–1623.

    Article  PubMed  CAS  Google Scholar 

  29. Pantuck A, Zisman A, Rauch MK, Belldegrun A: Incidental renal tumors. Urology 2000, 56:190–196. This is a literature review demonstrating improved 5-year survival rates for RCC compared with previous publications. Improved survival is likely secondary to improvement in imaging techniques.

    Article  PubMed  CAS  Google Scholar 

  30. Hoznek A, Salomon L, Antiphon P, et al.: Partial nephrectomy with retroperitoneal laparoscopy. J Urol 1999, 162:1922–1926.

    Article  PubMed  CAS  Google Scholar 

  31. Janetschek G, Jeschke K, Peschel R, et al.: Laparoscopic surgery for stage T1 renal cell carcinoma: radical nephrectomy and wedge resection. Eur Urol 2000, 38:131–138.

    Article  PubMed  CAS  Google Scholar 

  32. Harmon WJ, Kavoussi LR, Bishoff JT: Laparoscopic nephronsparing surgery for solid renal masses using the ultrasonic shear. Urology 2000, 56:754–759.

    Article  PubMed  CAS  Google Scholar 

  33. Rassweiler J, Abbou C, Janetschek G, Jeschke K: Laparoscopic partial nephrectomy. The European experience. Urol Clin North Am 2000, 27:721–736. This is a review of the technical aspects and the more common complications of LPN. Fifty-three patients at four European centers underwent LPN with resection of tumors ranging between 1.1 and 5 cm in diameter.

    Article  PubMed  CAS  Google Scholar 

  34. Winfield HN, Donovan JF, Lund GO, et al.: Laparoscopic partial nephrectomy: initial experience and comparison to the open surgical approach. J Urol 1995, 153:1409–1414.

    Article  PubMed  CAS  Google Scholar 

  35. McDougall E, Elbahnasy AM, Clayman RV: Laparoscopic wedge resection and partial nephrectomy--the Washington University experience and review of the literature. JSLS 1998, 2:15–23.

    PubMed  CAS  Google Scholar 

  36. Arnott J: Practical illustrations of the remedial efficacy of a very low or anaesthestic temperature in cancer. Lancet 1850, 2:257–259.

    Article  Google Scholar 

  37. Onik G, Reyes G, Cohen JK, Porterfield B: Ultrasound characteristics of renal cryosurgery. Urology 1993, 42:212–215.

    Article  PubMed  CAS  Google Scholar 

  38. Baust J, Gage AA, Ma H, Zhang CM: Minimally invasive cryosurgery: technological advances. Cryobiology 1997, 34:373–384.

    Article  PubMed  CAS  Google Scholar 

  39. Perry K, Zisman A, Pantuck A: Laparoscopic and percutaneous ablative techniques in the treatment of renal cell carcinoma. Rev Urol 2002, 4:103–111. This is a literature review of cryoablation, RFA, and other minimally invasive techniques for the management of small renal tumors.

    PubMed  Google Scholar 

  40. Stephenson R, King D, Rohr L: Renal cryoablation in a canine model. Urology 1996, 47:772–776.

    Article  PubMed  CAS  Google Scholar 

  41. Campbell S, Krishnamurthi V, Chow G, et al.: Renal cryosurgery: experimental evaluation of treatment parameters. Urology 1998, 52:29–34.

    Article  PubMed  CAS  Google Scholar 

  42. Gill IS, Novick AC, Meraney AM, et al.: Laparoscopic renal cryoablation in 32 patients. Urology 2000, 56:748–753.

    Article  PubMed  CAS  Google Scholar 

  43. Zisman A, Pantuck A, Cohen JK, Belldegrun A: Prostate cryoablation using direct transperitoneal placement of ultra-thin probes through a 17-gauge brachytherapy template: technique and preliminary results. Urology 2001, 58:988–993.

    Article  PubMed  CAS  Google Scholar 

  44. Pantuck A, Zisman A, Cohen J, Belldegrun A: Cryosurgical ablation of renal tumors using 1.5 mm ultra-thin probes. Urology 2002, 59:130–133.

    Article  PubMed  Google Scholar 

  45. Gill IS, Novick AC, Soble JJ, et al.: Laparoscopic renal cryoablation: initial clinical series. Urology 1998, 52:543–551.

    Article  PubMed  CAS  Google Scholar 

  46. Johnson B, Nakada S: Laparoscopic renal cryoablation for renal-cell cancer. J Endourol 2000, 14:873–878.

    PubMed  CAS  Google Scholar 

  47. Uchida M, Imaide Y, Sugimoto K, et al.: Percutaneous cryosurgery for renal tumours. Br J Urol 1995, 75:132–137.

    PubMed  CAS  Google Scholar 

  48. Long JP, Faller GT: Percutaneous cryoablation of the kidney in a porcine model. Cryobiology 1999, 38:89–93.

    Article  PubMed  CAS  Google Scholar 

  49. Rossi S, Di Stasi M, Buscarini E, et al.: Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am 1995, 1:73.

    PubMed  CAS  Google Scholar 

  50. de Berg J, Pattynama PM, Obermann WR, et al.: Percutaneous computer-tomography-guided thermocoagulation for osteoid osteomas. Lancet 1995, 346:350–351.

    Article  PubMed  Google Scholar 

  51. Zlotta AR, Wildschutz T, Raviv G, et al.: Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol 1997, 11:251–258.

    Article  PubMed  CAS  Google Scholar 

  52. McGovern FJ, Wood BJ, Goldberg N, Mueller P: Radiofrequency ablation of renal cell carcinoma via image guided needles. J Urol 1999, 161:599–600.

    Article  PubMed  CAS  Google Scholar 

  53. Gill I, Hsu T, Fox RL, et al.: Laparoscopic and percutaneous radiofrequency ablation of kidney: acute and chronic porcine study. Urology 2000, 56:197–200.

    Article  PubMed  CAS  Google Scholar 

  54. Rendon RA, Gertner MR, Sherar MD, et al.: Development of a radiofrequency based thermal therapy technique in an in vivo porcine model for the treatment of small renal masses. J Urol 2001, 166:292–298.

    Article  PubMed  CAS  Google Scholar 

  55. Walther M, Shawker TH, Libutti SK, et al.: A phase 2 study of radio frequency interstitial tissue ablation of localized tumors. J Urol 2000, 163:1424–1427.

    Article  PubMed  CAS  Google Scholar 

  56. Polascik T, Hamper U, Lee BR, et al.: Ablation of renal tumors in a rabbit model with interstitial saline-augmented radiofrequency energy: preliminary report of a new technology. Urology 1999, 53:382–383.

    Article  Google Scholar 

  57. Crowley J, Shelton J, Iverson AJ, et al.: Laparoscopic and computed tomography-guided percutaneous radiofrequency ablation of renal tissue: acute and chronic effects in an animal model. Urology 2001, 57:976–980.

    Article  PubMed  CAS  Google Scholar 

  58. Rukstalis D, Khorsandi M, Garcia FU, et al.: Clinical experience with open renal cryoablation. Urology 2001, 57:34–39.

    Article  PubMed  CAS  Google Scholar 

  59. Collyer W, Landman J, Olweny EO, et al.: Comparison of renal ablation with cryotherapy, dry radiofrequency, and saline augment radiofrequency in a porcine model. J Am Coll Surg 2001, 193:505–513.

    Article  PubMed  CAS  Google Scholar 

  60. Yim AP, Rendina EA, Hazelrigg SR, et al.: A new technological approach to nonanatomical pulmonary resection: saline enhanced thermal sealing. Ann Thorac Surg 2002, 74:1671–1676.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of California, Los Angeles, Box 951738, 90095, Los Angeles, CA, USA

    Michael W. Phelan MD

Authors
  1. Michael W. Phelan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kent T. Perry MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Gore MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter G. Schulam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Phelan, M.W., Perry, K.T., Gore, J. et al. Laparoscopic partial nephrectomy and minimally invasive nephronsparing surgery. Curr Urol Rep 4, 13–20 (2003). https://doi.org/10.1007/s11934-003-0052-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-003-0052-9

Keywords

Search

Navigation