Description:
Indications for laparoscopic partial nephrectomy include a solid renal mass in a patient with a solitary kidney or compromised contralateral kidney, bilateral renal masses, small localised renal tumours in patients with a normal contralateral kidney.
Some small tumours may not be suitable for treatment by laparoscopic partial nephrectomy because of their position (centrally located lesions are more difficult to remove than peripheral lesions).
The standard treatment for these indications would be an open partial nephrectomy, using a flank extraperitoneal or an anterior subcostal incision to expose the kidney.
A laparoscopic partial nephrectomy is performed under general anaesthetic, using a transperitoneal or retroperitoneal approach. In the transperitoneal approach, the abdomen is insufflated with carbon dioxide and three or four small abdominal incisions are made. In the retroperitoneal approach, a small incision is made in the back and a dissecting balloon is inserted to create a retroperitoneal space. After insufflation with carbon dioxide, two or three additional small incisions are made in the back. The renal vessels are identified and either isolated using vessel loops or clamped and the kidney is mobilised to allow exposure of the lesion. A laparoscopic ultrasound probe may be used to determine the line of incision and depth of tumour involvement. Bleeding vessels are sealed or ligated with sutures and the renal capsule is then closed. The specimen is enclosed in a bag and retrieved through an expanded port.
Hand-assisted laparoscopic partial nephrectomy allows the surgeon to place one hand in the abdomen while maintaining the pneumoperitoneum required for laparoscopy. A small incision is made that is just large enough for the surgeon's hand and an airtight 'sleeve' device is used to form a seal around the incision.
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