Current status of laparoscopic partial nephrectomy.

PURPOSE OF REVIEW: As familiarity with laparoscopic partial nephrectomy (LPN) has grown, application has expanded into increasingly complex cases. In this review, we present a recent series describing use of LPN in specific clinical scenarios and describe common technical modifications commonly employed in each case. In addition, we discuss modifications to standardly performed maneuvers. RECENT
FINDINGS: Partial nephrectomy was originally reserved for absolute indications and small peripheral masses. However, well tolerated utilization of LPN in larger and more complex tumors including those in hilar or central locations, in kidneys with multiple masses, and in patients with previous renal surgery have been described. Additionally, patients with comorbidities such as obesity, and anatomic variations including multiple renal vessels and solitary kidneys have also undergone LPN with success. Furthermore, modifications to standard techniques have helped improve perioperative characteristics, such as warm ischemia time, to levels comparable to open surgery. Although many of the LPN series are small, they represent the most recent novel applications of the technique.
SUMMARY: LPN is a continuously evolving technique, and with case specific modifications can be safely performed in a wide range of clinical scenarios by sufficiently experienced hands.