Laparoscopic partial nephrectomy: A procedure in evolution

Laparoscopic partial nephrectomy (LPN) was initially described in an animal model, and subsequently performed in a patient with pyelonephritis and stone disease in 1992. In an effort to decrease operative morbidity and improve laparoscopic hemostasis, numerous investigators have developed several techniques to facilitate the procedure. This article will outline the various techniques that are currently performed clinically, are in development, and also discuss the possibilities being developed for the future. The main techniques described and discussed are: Pure Laparoscopic Nephrectomy (duplication of open surgery), Cable-tie Tourniquet, Double-loop Renal Tourniquet, Endosnare, Hand-assisted Laparoscopic Partial Nephrectomy, Ultrasonic Shears, Radiofrequency Coagulation, Hydro-jet, Microwave and Holmium laser. In conclusion, it must be emphasized that for a procedure to be performed laparoscopically it must be demonstrate that the laparoscopic approach has the same or better efficacy with decreased morbidity when compared to open surgery. This is evident to laparoscopic radical nephrectomy. Whether the same will hold true for laraposcopic partial nephrectomy (LPN) has yet to be determined. Thus far, the reported techniques have demonstrated success in animal models and in small clinical series. As a result, LPN is certainly an efficacious procedure applicable in many cases. Nevertheless, LPN will not replace open partial nephrectomy for many tumors.