Emerging Nephron Sparing Treatments for Kidney Tumors: A Continuum of Modalities From Energy Ablation to Laparoscopic Partial Nephrectomy

Abstract

Compared to open partial nephrectomy the laparoscopic approach offers similar cancer-free survival rates. However, the procedure requires highly skilled surgeons. Of the energy based ablative treatments cryoablation followed by radio frequency ablation offers the most meaningful results, with promising local control rates indicated in some series. These methods can be performed less invasively than partial nephrectomy and require less surgical expertise. We anticipate that these modalities will be formalized into urological practice and serve as a single continuum of care, customized according to disease and surgical expertise.

The Kinetics of Thermal Injury in Human Renal Carcinoma Cells

“…36,40 However, in recent years, with the increasing ability to detect small asymptomatic RCC (<4 mm) by ultrasonography (US), computerized tomography (CT), and magnetic resonance imaging (MRI), minimally invasive thermal surgery using either heating (microwave, radiofrequency (RF), laser, and high intensity focused ultrasound (HIFU) thermal therapy) or freezing (cryosurgery) have been shown clinically to be very promising alternatives to traditional treatment modalities. 10,29,33,34,36 In the thermal surgical techniques using heating, cells/tissue is killed by a supraphysiological thermal history with time in seconds to minutes and peak temperature from 50 to 70 • C or more. 14 Therefore, knowledge of the cell injury kinetics in this temperature and time frame is very useful for predicting the treatment outcomes and hence improving the treatment protocols of thermal surgery.…”

Maximum tensile force of different suture techniques in reconstruction of the renal remnant after nephron-sparing surgery

“…On a standard basis, open nephron-sparing surgery has been used for renal carcinoma patients with a solitary kidney, bilateral synchronous tumors, or a systemic disease that could potentially jeopardize renal function [9]. However, due to the promising cancer-free survival rates for patients undergoing open nephron-sparing surgery for tumors smaller than 4 cm, this approach gains widespread acceptance for patients with a normally functioning contralateral kidney [10][11][12].…”

Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

“…Although previous studies have shown that LPN is a feasible and effective minimally invasive technique in the surgical treatment of selected patients with renal tumors, its potential risk of bleeding requiring transfusion is well known (7,8). Bleeding should be minimized to avoid hypovolemia, anemia, hemodynamic deterioration and exposure to the risk of transfusion (9).…”