Hand-Assisted Laparoscopic Partial Nephrectomy
Long-term outcome data confirm that partial nephrectomy performed in properly selected patients yields oncologic efficacy similar to that of conventional radical nephrectomy . Advances in laparoscopic surgery have made laparoscopic partial nephrectomy technically feasible. Laparoscopic partial nephrectomy (LPN) was first described in 1993 , 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 .
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.
KeywordsMethylene Blue Partial Nephrectomy Solitary Kidney Warm Ischemia Time Laparoscopic Partial Nephrectomy
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