Laparoscopic Partial Nephrectomy – Current State of the Art

Clayman et al described the first successful laparoscopic nephrectomy in 1991 [1]. Since that time, laparoscopic radical nephrectomy has become the standard of care for renal tumors. At the same time, the widespread use of contemporary imaging techniques has resulted in an increased detection of small incidental renal tumors. In efforts to avoid chronic kidney disease, the management of the small renal mass has trended away from radical nephrectomy toward nephron-conserving surgery. In 1993, successful laparoscopic partial nephrectomy (LPN) was first reported in a porcine model [2]. Winfield et al reported the first human LPN in 1993 [3]. From that time, centres around the world have developed laparoscopic techniques for partial nephrectomy through retroperitoneal and transperitoneal approaches. Classically, only small, peripheral, exophytic tumors were eligible for LPN, but larger, infiltrating tumors have been managed with LPN in more recent series [4].