Laparoscopic Partial Nephrectomy

فصل كتاب

2008

Binsaleh, Saleh . 2008

In 1991 Clayman et al. described the first successful laparoscopic nephrectomy . Since that time, laparoscopic radical nephrectomy for renal tumors has been routinely preformed in select patients worldwide. During this period, “elective” open partial nephrectomy has established itself as an efficacious therapeutic approach in the treatment of small renal masses  similar to that of radical nephrectomy in select patients with a small renal tumor. At the same time the widespread use of contemporary imaging techniques has resulted in an increased detection of small incidental renal tumors, in which the management, during the past decade, has been trended away from radical nephrectomy toward nephron-conserving surgery. In 1993 successful laparoscopic partial nephrectomy (LPN) was first reported in a porcine model , while Winfield et al reported the first human LPN in 1993 . From that time, several centers in the world have developed laparoscopic techniques for partial nephrectomy through retroperitoneal or transperitoneal approaches. In the beginning, only small, peripheral, exophytic tumors were wedge excised, but with experience, larger, infiltrating tumors have been managed similarly.
 LPN combines the advances and benefit of nephron sparing surgery and the laparoscopy to offer a decreased morbidity inherent to laparoscopy while preserving renal function offered by partial nephrectomy.
Technical difficulty in LPN is encountered when securing renal hypothermia, renal parenchymal hemostasis, pelvicalyceal reconstruction, and parenchymal renorraphy by pure laparoscopic techniques. Nevertheless, ongoing advances in laparoscopic techniques and operator skills have allowed the development of a reliable technique of laparoscopic partial nephrectomy, duplicating the established principles and technical steps underpinning open partial nephrectomy.
 In this chapter we evaluate the role of LPN in the nephron sparing armamentarium

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