Laparoendoscopic Single-site Partial Nephrectomy

Luca Cindolo, Petros Sountoulides, Luigi Schips
European Urological Review, 2011;6(2):132-135
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Abstract

Nephron-sparing surgery (NSS) ensures excellent oncological results and improves overall survival compared with radical nephrectomy when applied for the treatment of small renal masses. The laparoscopic approach, in the form of radical or partial nephrectomy, is nowadays established as the treatment modality of choice for the management of localised renal tumours. Laparoendoscopic single-site surgery (LESS) represents a step forwards in the evolution of minimally invasive surgery, which has been recently introduced in the field of NSS. Although still limited, the current experience with LESS NSS in selected renal masses has been estimated as more than encouraging. LESS NSS has been proven feasible for the non-novice laparoscopist, provides post-operative outcomes overlapping its standard laparoscopy counterpart and ensures subjective patient satisfaction. However, more extensive surgical experience and more prolonged follow-up periods are necessary to reach more definite conclusions on the technique and its place in the future surgical management of renal masses.
Keywords
Partial nephrectomy, laparoscopy, minimally invasive surgery, laparoendoscopic single-site surgery, renal cancer, warm ischaemia
Disclosure The authors have no conflicts of interest to declare.
Received: August 28, 2011 Accepted September 30, 2011
Correspondence: Luca Cindolo, via Anelli, 82 - 66054 Vasto, Italy. E: lucacindolo@virgilio.it

Kidney cancers are the most lethal malignancies of the urinary system. Renal cancer accounts for approximately 3 % of all adult malignancies and is associated with approximately 13,000 deaths annually.1

Renal cancer, apart from being lethal, or maybe because of it, has recently raised significant attention with regard to its aetiology, diagnosis and management. There have been significant developments in areas of research related to kidney cancer such as genetic mutations and considerable improvement of our understanding on the extent of associated chronic kidney disease (CKD). The benefits of nephron-sparing surgery (NSS) have been significantly appreciated when treating primary tumours, while recent advances in the field of immunotherapy and targeted systemic therapies have been achieved for the management of advanced and metastatic disease.2

Moreover, the kidney has traditionally been the organ of choice for the clinical implementation of advances in less- and minimally invasive surgical therapies since Clayman et al. performed the first laparoscopic nephrectomy.3

During the last decade, the widespread use of sophisticated imaging modalities has resulted in a significant increase in the incidental detection of kidney tumours. Nowadays more than 70 % of all renal cancer cases are ‘screen detected’ as incidental findings on imaging studies obtained for mostly unrelated reasons.4

This increased ratio of incidental diagnosis has resulted in a significant shift in the staging of renal cancer since lesser cases initially present with advanced metastatic disease and more cases of renal tumours are confined to the kidney at the time of diagnosis. As a result, NSS techniques – open, laparoscopic or robot-assisted partial nephrectomy and focused thermal ablative therapies (cryotherapy, radiofrequency ablation [RFA]) – have received increased attention in the last few years. In fact, partial nephrectomy (PN) is now considered the procedure of choice for T1a tumours and increasingly for T2.

This paradigm shift in the management of localised renal tumours has been recently reinforced by emerging data from clinical trials implying that patients following radical nephrectomy actually have a lower overall survival due to an increased rate of chronic renal insufficiency and related significant risk of cardiovascular morbidity.5–8

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