Current status of partial nephrectomy for renal mass

Abstract

The standard treatment for a small mass has shifted from radical nephrectomy to partial nephrectomy. The benefits of partial nephrectomy, including preserving renal function, prolonging overall survival, preventing postoperative chronic kidney disease, and reducing cardiovascular events, have been discussed in many studies. With the accumulation of surgeons' experience and simplification of the operative procedures, the warm ischemic time has become shorter despite the indication of tumor size becoming larger. With the help of intraoperative ultrasound, partial nephrectomy can be performed for an endophytic renal mass. Recently, laparoscopic partial nephrectomy has become well indicated for most renal tumors in many centers with advanced laparoscopic expertise. Open partial nephrectomy remains indicated for complex tumors. With technical innovation, robotic partial nephrectomy shows at least comparable perioperative outcomes with a benefit for challenging cases. Laparoendoscopic single-site partial nephrectomy has recently been tried in limited indications and seems to be feasible.

Keywords: Kidney neoplasms; Minimal invasive surgery; Nephrectomy.

FIG. 1

Procedures of robotic partial nephrectomy. (A) Marking renal arteries with vessel loops. (B) Confirming the endophytic tumor with intraoperative ultrasound. (C) Clamping renal arteries with bulldog clamps. (D) Resection of tumor. (E, F) Sliding-clip renorrhaphy.