Laparoscopic partial nephrectomy for RCC: how can we avoid ischemic damage of the renal parenchyma?

摘要

Surgery is the only curative therapeutic measure in patients with renal cell cancer and, therefore, has the central role in the management of this disease. Traditionally, open radical nephrectomy was considered the standard of care. Recently, however, alternative surgical strategies have been developed. The impact of laparoscopy has increased rapidly within the last years, and as a result, laparoscopic radical nephrectomy has become a recognised standard by the 2006 European Association of Urology guidelines. Parallel to this evolution in technique the indication for radical nephrectomy has also changed to a great extent. By means of imaging techniques such as ultrasonography and computed tomography scanning, an increasing number of small renal cancers are being detected incidentally. For the majority of these tumours nephrectomy is an over-treatment, and nephron-sparing surgery has to be considered instead even if there is a normally functioning contralateral kidney because oncologic results are as good as with radical nephrectomy. Many surgeons will now be confronted with the difficult situation that they can offer radical nephrectomy by means of laparoscopy to remove large tumours but are unable to perform laparoscopic nephron-sparing surgery for the small ones. Thus, great effort is now directed towards the development of reliable and reproducible techniques for laparoscopic partial nephrectomy.