Expanding Indications for Laparoscopic Partial Nephrectomy

摘要

Winfield etal.1 reported the first transperitoneal LPN in 1993. Then, Gill et al.13 described the technique of retroperitoneal LPN. LPN was initially reserved for the treatment of small, solitary, exophytic, and peripheral tumors.14 The principal technical challenge during LPN stems from the complexity of laparoscopic tumor excision and sutured renal reconstruction in a time-sensitive manner within an acceptable warm ischemia limit. To add to the challenges of an advanced operation is th? somewhat reduced tactile input during laparoscopy, which reduces the margin for error. Successful LPN for complex tumors primarily requires an in-depth understanding of the three-dimensional renal anatomy, an acute appreciation of visual cues during laparoscopy, and masterful ambidextrous handling of a myriad of laparoscopic instruments.