Radical Nephrectomy

Laparoscopic radical nephrectomy represents a watershed event in urologic oncology because it provided an alternative for removing a large solid organ using a minimally invasive approach. It continues to gain worldwide popularity and is becoming a standard procedure for the appropriate patient with an organ-confined T1 or T2 renal tumor. Depending on the individual patient characteristics, and particularly the training and expertise of the surgeon, either the transperitoneal or the retroperitoneal laparoscopic approach can be used. The retroperitoneal approach affords quicker access to the renal hilum and easier dissection in obese patients. However, it is a more difficult procedure to master, partly because the smaller working space makes entrapping the kidney more difficult, increasing the risk of conversion to open surgery. Urologists without a great deal of laparoscopic experience are advised to choose the transperitoneal approach.