Minimally invasive radical nephrectomy: a contemporary review

Abstract

Minimally invasive renal surgery has revolutionized the surgical management of renal cancer since the initial report of laparoscopic nephrectomy in 1991. Laparoscopic nephrectomy became the mainstay of management in surgically resectable renal masses since the 1990s. The growing body of literature supporting nephron-sparing surgery over the last two decades has meant that minimally invasive radical nephrectomy (MI-RN) is now the preferred treatment for renal tumors not amenable to partial nephrectomy. While there is a well-described experience with complex radical nephrectomy using standard laparoscopy, robot-assisted surgery has shortened the learning curve and facilitated greater uptake of minimally invasive surgery in difficult surgical scenarios traditionally performed open surgically. Increased experience and expertise with robot-assisted renal surgery has led to expansion of the indications for MI-RN to include larger masses, locally advanced renal masses invading adjacent tissues or regional hilar/ retroperitoneal lymph nodes, cytoreductive nephrectomy (CN) in metastatic disease, and concurrent venous tumor thrombectomy for renal vein or inferior vena cava (IVC) involvement. In this article, we review the various surgical techniques and adjunctive procedures associated with MI-RN.

Effect of Inferior Vena Cava Tumor Thrombus on Overall Survival in Metastatic Renal Cell Carcinoma Patients Treated with Cytoreductive Nephrectomy

“…Finally, it must be highlighted that the current study population represents a rare, yet challenging, subgroup of mRCC patients when CN is undertaken. Assessment and perioperative risk management as well as defining the most appropriate surgical approach (open vs laparoscopic vs robotic assisted) for each patient individually, represent the crucial steps to minimize the risk of perioperative complications in such complex and a priori complicated procedures [21] , [22] , [23] , [24] , [25] .…”

Simplifying Laparoscopic Nephrectomy for Beginners: Double Window Technique With En Bloc Hilar Stapling

“…The first laparoscopic nephrectomy was performed in the early 1990s and since then it has become the standard of care in the management of kidney pathologies [ 6 ]. The distinct advantages of laparoscopic nephrectomy over its open counterpart are smaller incisions, less pain, early recovery, and decreased hospitalization time [ 7 , 8 ]. The technical advancements, surgical refinement, availability of better energy, and ultrasonic devices have significantly decreased the operating time and decreased the complications.…”

Operative Techniques and Outcomes in Laparoscopic Radical Nephrectomy

“…Initially, LRN was preferred for small renal tumors (<4 cm); however, with increasing experience, LRN has been adopted as the standard of care for larger renal tumors as well with good perioperative and oncological outcomes [1].…”

“…LRN is now also considered for large or central renal masses where a nephronsparing surgery is not possible [1].…”

“…Renal malignancy is amongst the 10 most commonly diagnosed cancers in both males and females [1]. It is twice more common in men than in women [2].…”