Laparoscopic partial nephrectomy: current status.

OBJECTIVE Increasingly nephro-sparing partial nephrectomy has became widely accepted as a preferred treatment option for the select patient when the adenocarcinoma involves a solitary kidney or poorly functioning contralateral kidney, and in patients with synchronous bilateral tumors. While open partial nephrectomy is currently the standard nephron sparing procedure for treatment of renal tumors, laparoscopic partial nephrectomy has emerged as a potential alternative recently. METHODS This review seeks a critical assessment of the current status of laparoscopic partial nephrectomy, worldwide results and a brief description of energy based in-situ tumor ablation systems. We have duplicated laparoscopically, the open surgical techniques. While choice of laparoscopic approach depends upon the surgeon's personal preference, the precise location of the tumor on the kidney is the main factor determining our either retroperitoneal or transperitoneal approach. Hilar clamping reliably achieves a bloodless field, decreases renal turgor and allows surgical precision during tumor excision and control of larger vessels, which represents a real, practical and significant advantage. Precise suture repair currently remains the optimal and most reliable method for sealing a collecting system entry during the course of a laparoscopic partial nephrectomy. With increasing experience, laparoscopic partial nephrectomy can be safely applied to renal tumors that extend deeply, even upto the renal sinus. CONCLUSIONS As more data emerges and the technical success rates of laparoscopic partial nephrectomy improve this minimally invasive technique will gain a wider role in the treatment of select renal cell carcinomas.