Indications and the Role of Laparoscopic Partial Nephrectomy

ContextMost renal cell carcinomas today are diagnosed incidentally at an early stage as small renal masses. Partial nephrectomy (PN) has become an established curative treatment in these indications and is mainly performed through open surgery.ObjectiveLaparoscopic PN (LPN) is an attractive alternative to open PN (OPN). In this article are reviewed the indications, the surgical specificities, and different options for standardisation and optimisation of LPN.Evidence acquisitionLPN should duplicate the principles of open surgery to get the same oncologic and complication outcomes. This is the case in experienced hands.Evidence synthesisThe role of LPN is, to date, restricted to high-volume laparoscopic centres. Indications should be adapted to each surgeon experience, keeping in mind that the goal of LPN is to safely remove a tumour with the lowest renal and surgical complications in a limited operative time to keep the warm ischemia time to <30 min. Surgical improvements and robot-assisted laparoscopy are two major aspects of the future development of LPN.ConclusionsLPN is a demanding surgical procedure and is so far limited to some specialised centres. New developments will potentially allow a wider use of this minimally invasive procedure.