Advancements in Laparoscopic Partial Nephrectomy: Expanding the Feasibility of Nephron-Sparing

Abstract

Partial nephrectomy (PN) offers equivalent oncologic outcomes to radical nephrectomy (RN) but has greater preservation of renal function and less risk of chronic kidney disease and cardiovascular disease. Laparoscopic PN remains underutilized likely because it is a technically challenging operation with higher rates of perioperative complications compared to open PN and laparoscopic RN. A review of the latest PN literature demonstrates that recent advancements in laparoscopic approaches, imaging modalities, ischemic mitigating strategies, renorrhaphy techniques, and hemostatic agents will likely allow greater utilization of LPN and expand its usage to increasingly more complex tumors.

Improved laparoscopic nephron-sparing surgery for renal cell carcinoma based on the precise anatomy of the nephron

“…Therefore, for patients who have kidney ailments, which may endanger renal function, or renal tumors at the T1a clinical stage, LNSS is the recommended surgery (8). The core technologies of LNSS include controlling the warm ischemia time, guaranteeing a negative margin and avoiding the occurrence of secondary bleeding and urine leakage (5). Continuous research and improvements have been developed for these surgical aspects, including suture techniques, renal hypothermia protection technology, hemostatic materials and ureteral stents (9–12).…”

“…Laparoscopic NSS (LNSS) has become more common in the treatment of RCC and has the advantages of little trauma, quick recovery and a similar effect to open surgery (4). The core technologies of LNSS include controlling the warm ischemia time, guaranteeing a negative margin and avoiding the occurrence of secondary bleeding and urine leakage (5). Based on the constantly updated knowledge regarding renal anatomy and the anatomical structure of the nephron, certain improvements were made to the LNSS technique, which was then used to treat 31 patients with RCC in the present study.…”

Robotic-Assisted Partial Nephrectomy: Experience on 60 Cases

“…Second, the “wrist” of the robotic arms has 7 of freedom, which allow the surgeon better control over certain aspects of the operation, most importantly precise suturing with minimal tissue manipulation. The technological advantages of RPN over conventional laparoscopy may allow novice surgeons a shorter learning curve (13).…”