Laparoscopic Partial Nephrectomy

Laparoscopic Partial Nephrectomy is a minimally invasive technique where a portion of the kidney is removed that is usually used as a treatment for primary renal tumours.

The advantage of partial nephrectomy when compared to radical nephrectomy is the preservation of as much kidney as possible to prevent subsequent problems surrounding kidney failure.

Some small tumours may not be well suited 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 done 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 created in the back and a dissecting balloon is inserted to make a retroperitoneal space. Once the insufflation with carbon dioxide is done, two or three additional small incisions are made in the back. The renal vessels are recognised 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 check the line of incision and depth of tumour involvement. Bleeding vessels are sealed with sutures and the renal capsule is then closed. The specimen is enclosed in a bag and fetched 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 will be used to form a seal around the incision.