Laparoscopic partial nephrectomy techniques: developments and translation.

Abstract

Laparoscopic partial nephrectomy has recently emerged as a potential surgical option for select renal masses. Several new techniques and devices that may aid in laparoscopic partial nephrectomy are reviewed. I review several techniques studied and/or developed in our laboratory. Each technique was evaluated for effectiveness in the porcine model and is in translation to clinical practice. Three techniques are reviewed. A hand assisted approach incorporating renal hilar clamping with hypothermia has proven successful for complex and multifocal lesions. Recent clinical studies, and our laboratory and clinical experience have shown a saline cooled monopolar dissector to be a valuable adjunct. A new and simple technique of achieving rapid hypothermia using a pure laparoscopic approach is described. Laparoscopic partial nephrectomy continues to develop as a standard of care for select renal masses. New devices and techniques will continue to make the procedure safer and reproducible.