Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

Abstract

This article aims to summarise recent developments in surgical and minimally invasive therapies in the management of small renal masses (SRM). Recent FindingsThe incidence of the small renal mass is increasing. Standard management of the SRM is partial nephrectomy. More recently, use of ablative techniques to manage the SRM has been increasing and an exciting array of technical advances are currently being made in the field.Nephron-sparing surgery looks set to become more financially viable with the advent of newer robotic platforms and, potentially even less invasive with the evaluation of single-port access. Real-time imaging promises to improve tumour definition, nephron preservation and vascular management intraoperatively. SummaryAdvances in surgical and minimally invasive therapies for the management of the SRM have the potential to improve cancer clearance and long-term renal function preservation. Patients will experience safer, more reliable and less invasive treatments for their small renal tumours. We describe the current advances underlying these changes.

Superselective renal artery embolization for treatment of urological hemorrhage after partial nephrectomy in a solitary kidney

“…1 Complications may occur occasionally following an embolization procedure, with a risk of inadvertent parenchymal infarction. [5][6][7] Progressive advances in interventional radiographic techniques, such as enhanced imaging and the introduction of smaller devices, as well as more accurate embolic agents, have made superselective embolization of the renal artery an effective approach to diagnosis and treatment of renal hemorrhage. 1,2 In general, it requires a short hospital stay, yields a rapid recovery, is usually performed without the need for general anesthesia and with low rates of early and late complications, [4][5][6] limiting the classical surgical approach with nephrectomy to exceptional cases only.…”

“…[5][6][7] Progressive advances in interventional radiographic techniques, such as enhanced imaging and the introduction of smaller devices, as well as more accurate embolic agents, have made superselective embolization of the renal artery an effective approach to diagnosis and treatment of renal hemorrhage. 1,2 In general, it requires a short hospital stay, yields a rapid recovery, is usually performed without the need for general anesthesia and with low rates of early and late complications, [4][5][6] limiting the classical surgical approach with nephrectomy to exceptional cases only. 3,4 Various embolic agents have been described in the literature for controlling bleeding in the renal region, but most series report embolization with coils as the preferred technique for renal artery embolization in several clinical scenarios.…”

“…3,4 Various embolic agents have been described in the literature for controlling bleeding in the renal region, but most series report embolization with coils as the preferred technique for renal artery embolization in several clinical scenarios. [6][7][8][9][10] This was the option chosen in the case reported here because it has some advantages compared to other methods. It is easy to manipulate, with controlled detachment into the target vessel only, promoting a minimal area of renal ischemia, since it does not close the distal microcirculation.…”

Ablation Therapies in Small Renal Masses

“…Radiofrequency ablation (RFA) that provides high-temperature necrosis of tumor cells and cryotherapy method that provides freezing necrosis of the cells can be cited as examples of thermal ablation. Electroporation, which causes cell death by causing permanent pores in the cell membrane, is an example for non-thermal ablation (7,8).…”

“…According to current guidelines, the gold standard in small renal masses is reported as partial nephrectomy (19). According to European guidelines, ablation therapies in small renal masses are recommended in cases where the patient is not suitable for surgical treatment and has a multifocal malignant tumor as mentioned above in the patient selection section (7,20).…”