ReviewLaparoscopic partial nephrectomy

- Imaging of the renal mass (CT or MRI) must be present at time of surgery to confirm laterality and facilitate intraoperative decision-making.
- For obese patients, all trocar ports can be shifted laterally to help facilitate visualization and mobilization of the kidney.
- Intraoperative laparoscopic ultrasonography plays a key role in identifying margin and depth of tumor and is critical in resection of larger and more endophytic lesions.
- Off-clamp approach is ideally used for smaller and peripheral lesions while selective arterial clamping and VMD can be applied for more hilar and central tumors.
- There is no known safe threshold of warm ischemia time as each minute sequentially contributes to risk of developing acute kidney injury and long-term decline. Renal function following LPN is dependent on quality, quantity, and quickness - Rule of three Q's.

Laparoscopic partial nephrectomy (LPN) compares favorably to traditional open nephron-sparing surgery (NSS) in terms of oncologic and surgical principles for kidney tumors. Studies have shown the modality to be feasible with similar oncologic efficacy and superior renal functional outcomes compared with laparoscopic radical nephrectomy (LRN) for tumors. The main advantages of LPN include marked improvements in estimated blood loss, decreased surgical site pain, shorter postoperative convalescence, better cosmesis, and nephron preservation. This review article evaluates the literature regarding LPN and discusses the main steps of the operation, the perioperative workup and management, surgical complications, and its role in the surgical management of kidney masses.