Fluorescence in Partial Nephrectomy
Since first described in 1991, laparoscopy has become highly approved in renal surgery, particularly in laparoscopic radical nephrectomy (Clayman et al., N Engl J Med 324:1370–1371, 1991). In addition to the steep learning curve, one major point of criticism in laparoscopic partial nephrectomy is the prolonged warm ischemia time (Gill et al., J Urol 170:64–68, 2003). Hence, several techniques like early unclamping of the renal hilum were established to reduce ischemic injury to the kidney. Also the use of the enhanced instruments and improved vision in robotic surgery has an influence in reducing warm ischemia time. However, those above-mentioned laparoscopic techniques continued to require disruption of the entire arterial blood flow during tumor resection. An additional point of criticism is the missing haptic feedback. While tumor identification can also be challenging in more endophytic renal tumors in open surgery, the lack of a tactile senor system in laparoscopy and robotic surgery may lead to an even more difficult definition of the exact tumor boundaries.
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