Advertisement

Hand-Assisted Laparoscopic Partial Nephrectomy

  • Abhay Rané

Long-term outcome data confirm that partial nephrectomy performed in properly selected patients yields oncologic efficacy similar to that of conventional radical nephrectomy [1]. Advances in laparoscopic surgery have made laparoscopic partial nephrectomy technically feasible. Laparoscopic partial nephrectomy (LPN) was first described in 1993 [5], and is now an accepted technique for small-volume renal tumors. Patients with exophytic renal masses <4 cm are ideal candidates; however, larger tumors may be considered in selected cases with poor renal function, a solitary kidney, bilateral tumors, or genetic predisposition to renal tumors [2].

An LPN can be completed by standard laparoscopic, robotic, or hand-assisted techniques. The main challenge to the wider deployment of this technique is its technical difficulty. Tumor excision, hemostasis, and reconstruction of collecting system breaches require proficiency and skill with intracorporeal suturing techniques; the issue is further compounded with the necessity to achieve the result expeditiously to minimize warm ischemia times. As in radical nephrectomy, the hand has emerged as yet another effective tool for achieving hemostasis and aiding dissection during laparoscopic nephron-sparing surgery [3,4,6]. Hand assistance helps manipulate the kidney and dissect the mass; it also helps gain easier access to the upper pole.

Keywords

Methylene Blue Partial Nephrectomy Solitary Kidney Warm Ischemia Time Laparoscopic Partial Nephrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Manikandan R, Srinivasan V, Rané A (2004) Which is the real gold standard for small-volume renal tumors? Radical nephrectomy versus nephron-sparing surgery. J Endourol 18:39.PubMedCrossRefGoogle Scholar
  2. 2.
    Singh D, Rubinstein M, Gill I (2005) Laparoscopic partial nephrectomy. J Endourol 19:454.Google Scholar
  3. 3.
    Stifelman MD, Sosa RE, Nakada SY, et al (2001) Hand-assisted laparoscopic partial nephrectomy. J Endourol 15:161.PubMedCrossRefGoogle Scholar
  4. 4.
    Strap SE, Hubosky S (2004) Hand-assisted laparoscopic partial nephrectomy. J Endourol 18:345.CrossRefGoogle Scholar
  5. 5.
    Winfield HN, Donovan JP, Godet AS, Clayman RV (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 7:52.CrossRefGoogle Scholar
  6. 6.
    Wolf JS Jr, Seifman BD, Montie JK (2000) Nephron sparing surgery for suspected malignancy: Open surgery compared to laparoscopy with selective use of hand assistance. J Urol 163:1659.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2009

Authors and Affiliations

  • Abhay Rané
    • 1
  1. 1.East Surrey HospitalRedhillUK

Personalised recommendations