Summary
Partial nephrectomy is emerging as the standard of care for small exophytic renal tumors <4 cm regardless of renal function status. In comparison to radical nephrectomy, studies have demonstrated equivalent oncologic control and decreased risk of renal insufficiency. While laparoscopic radical nephrectomy has been widely adopted as the procedure of choice for large renal masses, laparoscopic partial nephrectomy (LPN) requires a higher level of expertise. However, recent advances in technology, instrument design, and greater facility with laparoscopy among urologists have made this procedure more accessible. There is little long-term follow-up, but some recent large series demonstrate positive margins <3% and local recurrence <5%, commensurate with the open procedure. A transperitoneal approach is often used for anterior and polar tumors and a retroperitoneal approach for posterior and posterolateral lesions; however, if hilar control is felt to be needed, then a transperitoneal approach is usually used regardless of the lesion’s location. In addition to standard laparoscopy, a hand-assisted approach can be used to facilitate suturing during renal reconstruction. Warm ischemia, up to 30 min, is usually necessary for large, complex, or centrally located tumors. When longer periods of warm ischemia are anticipated, cold ischemia may be employed via surface, transureteral, or intraarterial cooling. Advances in surgical sealants continue to facilitate hemostasis; these include glues as well as hemostatic agents.
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References
Hock LM, Lynch J, Balaji KC (2002) Increasing incidence of all stages of kidney cancer in the last two decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol 167:57–60
Novick AC (2004) Laparoscopic and partial nephrectomy. Clin Cancer Res 10:6322s–6327s
Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Long SR, Roemer FD, Pingleton ED, Thompson PG (1991) Laparoscopic nephrectomy. N Engl J Med 324:1370–1371
Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thompson PG, Long SR (1991) Laparoscopic nephrectomy: initial case report. J Urol 146:278–282
Zisman A, Pantuck AJ, Belldegrun AS, Schulam PG (2001) Laparoscopic radical nephrectomy. Semin Urol Oncol 19:114–122
Novick AC (2002) Surgery of the kidney. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ (eds) Campbell’s urology, 8th edn. Saunders, Philadelphia, pp 3570–3643
Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P (2000) Surgical management of renal tumors 4cm. or less in a contemporary cohort. J Urol 163:730–736
Hafez KS, Novick AC, Butler BP (1998) Management of small solitary unilateral renal cell carcinomas: impact of central versus peripheral tumor location. J Urol 159:1156–1160
Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollan PC, Eickholt JT, Zincke H (2002) Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 167:884–889
McKiernan J, Simmons R, Katz J, Russo P (2002) Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 59:816–820
Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75:1236–1242
Moll V, Becht E, Zigler M (1993) Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients. J Urol 150:319–323
Steinbach F, Stockle M, Hohenfellner R (1995) Clinical experience with nephronsparing surgery in the presence of a normal contralateral kidney. Semin Urol Oncol 13:288–291
D’Armiento M, Damiano R, Felepa B, Perdona S, Oriani G, De Sio M (1997) Elective conservative surgery for renal carcinoma versus radical nephrectomy: a prospective study. Br J Urol 79:15–19
Hafez KS, Fergany AF, Novick AC (1999) Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 162:1930–1933
Barbalias GA, Liatsikos EN, Tsintayis A, Nikiforidis G (1999) Adenocarcinoma of the kidney: nephron-sparing surgical approach vs radical nephrectomy. J Surg Oncol 72:156–161
Belldegrun A, Tsui KH, deKernion JB, Smith RB (1997) Efficacy of nephron-sparing surgery for renal cell carcinoma: analysis based on the new 1997 Tumor-Node-Metastasis Staging System. J Clin Oncol 17:2868–2875
Herr HW (1999) Partial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year followup. J Urol 161:33–34
Fergany AF, Hafez KS, Novick AC (2000) Long-term results of nephron-sparing surgery for localized renal cell carcinoma: 10 year follow-up. J Urol 163:442–445
Winfield HN, Donovan JF, Godet AS, Clayman RV (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 7:521–526
McDougall EM, Clayman RV, Chandhoke PS, Kerbl K, Stone AM, Wick MR, Hicks M, Figenshau RS (1993) Laparoscopic partial nephrectomy in the pig model. J Urol 149:1633–1636
McDougall EM, Clayman RV, Anderson K (1993) Laparoscopic wedge resection of a renal tumor: initial experience. J Laparoendosc Surg 3:577–581
Gill IS, Delworth MG, Munch LC (1994) Laparoscopic retroperitoneal partial nephrectomy. J Urol 152:1539–1542
Rassweiler JJ, Abbou C, Janetschek G, Jeschke K (2000) Laparoscopic partial nephrectomy. The European experience. Urol Clin North Am 27:721–736
Allaf ME, Bhayani SB, Rogers C, Varkarakis I, Link RE, Inagaki T, Jarrett TW, Kavoussi LR (2004) Laparoscopic partial nephrectomy: evaluation of long-term oncological outcome. J Urol 172:871–873
Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, Thornton J, Sherief MH, Strzempkowski B, Novick AC (2003) Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 170:64–68
Janetschek G, Jeschke K, Peschel R, Strohmeyer D, Henning K, Bartsch G (2000) Laparoscopic surgery for stage T1 renal cell carcinoma: radical nephrectomy and wedge resection. Eur Urol 38:131–138
Guillonneau B, Bermudez H, Gholami S, Fettouh HE, Gupta R, Rosa JA, Baumert H, Cathelineau X, Fromont G, Vallancien G (2003) Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 169:483–486
Kim FJ, Rha KH, Hernandez F, Jarrett TW, Pinto PA, Kavoussi LR (2003) Laparoscopic radical versus partial nephrectomy: assessment of complications. J Urol 170:408–411
Orvieto MA, Chein GW, Laven B Rapp DE, Sokoloff MH, Shalhav AL (2004) Eliminating knot tying during warm ischemia time for laparoscopic partial nephrectomy. J Urol 172:2292–2295
Bhayani SB, Rha KH, Pinto PA, Ong AM, Allaf ME, Trock BJ, Jarrett TW, Kavoussi LR (2004) Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine. J Urol 172:1264–1266
Strup SE, Hubosky S (2004) Hand-assisted laparoscopic partial nephrectomy. J Endourol 18:345–349
Ramani AP, Desai MM, Steinberg AP Ng CS, Abreu SC, Kaouk JH, Finelli A, Novick AC, Gill IS (2005) Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 173:42–47
Hafez KS, Novick AC, Campbell SC (1997) Patterns of tumor recurrence and guidelines for followup after nephron-sparing surgery for sporadic renal cell carcinoma. J Urol 157:2067–2070
Montie JE (1994) Follow-up after partial or total nephrectomy for renal cell carcinoma. Urol Clin North Am 21:589–592
Capeluto CC, Kavoussi LR (1993) Complications of laparoscopic surgery. Urology 42:2–12
Coll DM, Uzzo RG, Herts BR, Davros WJ, Wirth SL, Novick AC (1999) 3-dimensional volume rendered computerized tomography for preoperative evaluation and intraoperative treatment of patients undergoing nephron sparing surgery. J Urol 161:1097–1102
Herrell SD (2004) Laparoscopic partial nephrectomy techniques: developments and translation. J Urol 172:2553–2556
Gettman MT, Blute ML, Chow GK, Neururer R, Bartsch G, Peschel R (2004) Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology 64:914–918
Bove P, Bhayani SB, Rha KH, Allaf ME, Jarrett TW, Kavoussi LR (2004) Necessity of ureteral catheter during laparoscopic partial nephrectomy. J Urol 172:458–460
Wolf JS Jr, Seifman BD, Montie JE (2000) Nephron sparing surgery for suspected malignancy: open surgery compared to laparoscopy with selective use of hand assistance. J Urol 163:1659–1664
Nadelhaft P, Nimmermann A, Bishop MC (1981) Arterial and pedicle occlusion in the hypothermic pig kidney. Urol Res 9:169–173
Kubinski DJ, Clark PE, Assimos DG, Hall MC (2004) Utility of frozen section analysis of resection margins during partial nephrectomy. Urology 64:31–34
Zucchi A, Mearini L, Mearini E Costantini E, Vivacqua C, Porena M (2003) Renal cell carcinoma: histological findings on surgical margins after nephron-sparing surgery. J Urol 169:905–908
Li QL, Guan HW, Zhang LZ, Zhang LZ, Wang FP, Liu YJ (2003) Optimal margin in nephron-sparing surgery for renal cell carcinoma 4 cm or less in diameter. Eur Urol 44:448–451
Sutherland SE, Resnick MI, Maclennan GT, Goldman HB (2002) Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol 167:61–64
Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA (2004) The natural history of incidentally detected small renal masses. Cancer 100:738–745
Bosniak MA, Birnbaum BA, Krinsky GA, Waisman J (1995) Small renal parenchymal neoplasms: further observations on growth. Radiology 197:589–597
Novick AC (1983) Renal hypothermia: in vivo and ex vivo. Urol Clin North Am 10:637–644
Ward JP (1975) Determination of the optimum temperature for regional hypothermia during temporary renal ischemia. Br J Urol 47:17–24
Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166:6–18
Wahlberg E, Dimuzio PJ, Stoney RJ (2002) Aortic clamping during elective operations for infrarenal disease: the influence of clamping time on renal function. J Vasc Surg 36:13–18
Nicholson ML, Metcalfe MS, White SA, Waller JR, Doughman TM, Horsburgh T, Feehally J, Carr SJ, Veitch PS (2000) A comparison of the results of renal transplantation from non-heart-beating, conventional cadaveric, and living donors. Kidney Int 58:2585–2591
Baldwin DD, Maynes LJ, Berger KA, Desai PJ, Zuppan CW, Zimmerman GJ, Winkielman AM, Sterling TH, Tsai CK, Ruckle HC (2004) Laparoscopic warm renal ischemia in the solitary porcine kidney model. Urology 63:592–597
Laven BA, Orvieto MA, Chuang MS, Ritch CR, Murray P, Harland RC, Inman SR, Brendler CB, Shalhav AL (2004) Renal tolerance to prolonged warm ischemia time in a laparoscopic versus open surgery porcine model. J Urol 172:2471–2474
Gill IS, Desai MM, Kaouk JH, Meraney AM, Murphy DP, Sung GT, Novick AC (2002) Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 167:469–470
Gill IS, Abreu SC, Desai MM, Steinberg AP, Ramani AP, Ng C, Banks K, Novick AC, Kaouk JH (2003) Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol 170:52–56
Ames CD, Venkatesh R, Weld KJ, Perrone M, Landman J (2004) Laparoscopic renal parenchymal hypothermia with a novel ice-slush deployment mechanism. J Endourol 18:A7
Munver R, Threatt CB, Robertson CN (2003) Intra-arterial renal hypothermia for nephron-sparing surgery: initial experience and long-term follow-up. J Urol 169:4
Janetschek G, Al-Zahrani H, Vrabec G, Al-Zahrani H, Leeb K, Gschwendtner M (2003) Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol 171:68–71
Jones WR, Politano V (1963) The effects of renal artery occlusion on renal function under normothermic and regional hypothermia. J Urol 89:535–541
Crain DS, Spencer CR, Favata MA, Amling CL (2004) Transureteral saline perfusion to obtain renal hypothermia: potential application in laparoscopic partial nephrectomy. J Soc Laparosc Surg 8:217–222
Landman J, Rehman J, Sundaram CP, Bhayani S, Monga M, Pattaras JG, Gokden N, Humphrey PA, Clayman RV (2002) Renal hypothermia achieved by retrograde intracavitary saline perfusion. J Endourol 16:445–449
Park EL, Ulreich JB, Scott KM, Ullrich NP, Linehan JA, French MH, Ho WY, White MJ, Talley JR, Fellah AM, Ramakumar S (2004) Evaluation of polyethylene glycol based hydrogel for tissue sealing after laparoscopic partial nephrectomy in a porcine model. J Urol 172:2446–2450
Collyer WC, Landman J, Olweny EO, Andreoni C, Kibel A, Andriole GL, Bostwick DG, Sundaram CP, Clayman RV (2002) Laparoscopic partial nephrectomy with a novel electrosurgical snare in a porcine model. J Endourol 16:673–679
Lotan Y, Gettman MT, Lindberg G, Napper CA, Hoopman J, Pearle MS, Cadeddu JA (2004) Laparoscopic partial nephrectomy using holmium laser in a porcine model. J Soc Laparosc Surg 8:51–55
Sundaram CP, Rehman J, Venkatesh R, Lee D, Rageb MM, Kibel A, Landman J (2003) Hemostatic laparoscopic partial nephrectomy assisted by a water-cooled, highdensity, monopolar device without renal vascular control. Urology 61:906–909
Urena R, Mendez F, Woods M, Thomas R, Davis R (2004) Laparoscopic partial nephrectomy of solid renal masses without hilar clamping using a monopolar radio frequency device. J Urol 171:1054–1056
Stern JA, Simon SD, Ferrigni RG, Andrews PE (2004) TissueLink device for laparoscopic nephron-sparing surgery. J Endourol 18:455–456
Tan YH, Young MD, L’Esperance JO, Preminger GM, Albala DM (2004) Handassisted laparoscopic partial nephrectomy without hilar vascular clamping using a saline-cooled, high-density monopolar radiofrequency device. J Endourol 18:883–887
Terai A, Ito N, Yoshimura K, Ichioka K, Kamoto T, Arai Y, Ogawa O (2004) Laparoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors: usefulness and complications. Eur Urol 45:744–748
Michaels MJ, Rhee HK, Mourtzinos AP, Summerhayes IC, Silverman ML, Libertino JA (2002) Incomplete renal tumor destruction using radio frequency interstitial ablation. J Urol 168:2046–2049
Rendon RA, Kachura JR, Sweet JM (2002) The uncertainty of radiofrequency treatment of renal cell carcinoma: findings at intermediate and delayed nephrectomy. J Urol 167:1587–1592
Kohrmann KU, Michel MS, Gaa J, Marlinghaus E, Alken P (2002) High intensity focused ultrasound as noninvasive therapy for multilocal renal cell carcinoma: case study and review of the literature. J Urol 167:2397–2403
Marberger M, Schatzl G, Cranston D, Kennedy JE (2005) Extracorporeal ablation of renal tumours with high-intensity focused ultrasound. BJU Int 95:52–55
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Borin, J.F., Clayman, R.V. (2006). Laparoscopic Partial Nephrectomy. In: Naito, S., Hirao, Y., Terachi, T. (eds) Endourological Management of Urogenital Carcinoma. Recent Advances in Endourology, vol 7. Springer, Tokyo. https://doi.org/10.1007/4-431-27786-2_2
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DOI: https://doi.org/10.1007/4-431-27786-2_2
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