Laparoscopic partial nephrectomy: integration of an advanced laparoscopic technique.

BACKGROUND Laparoscopic radical nephrectomy and open partial nephrectomy are now established methods of treatment for appropriate renal lesions suspicious for malignancy, Laparoscopic partial nephrectomy has undergone progressive evolution. The aim of this paper is to; (i) evaluate the current status of laparoscopic partial nephrectomy, and (ii) to place it in the Australian and New Zealand context by evaluating the necessary skill acquisition for advanced laparoscopic urology. METHODS The National Library of Medicine database (PubMed) was used to specifically search the available literature on laparoscopic partial nephrectomy, renal failure and nephrectomy, modular surgical training and laparoscopic training. Of the articles identified, selection was based on their contribution to the development of techniques, progressive clinical outcomes, as well as comparisons with current management. RESULTS The technique and outcomes of laparoscopic partial nephrectomy are now secure enough to treat anatomically complex tumours in laparoscopically experienced hands. For the appropriate patient with a small renal mass, the impact of radical nephrectomy and long-term renal dysfunction needs to be considered, even in the presence of a normal contra-lateral kidney. Robotic assisted laparoscopic surgery is expensive and may impair the acquisition of advanced iaparoscopic skills. CONCLUSION Over the past 5 years, laparoscopic partial nephrectomy has developed to the stage where, with the necessary laparoscopic skill, it is now a standard of care at tertiary referral institutions. Widespread dissemination of advanced laparoscopic skills remains the next challenge.