title: Minimally invasive therapy for renal cell carcinoma: is there a new community standard?
abstract: OBJECTIVE
  To evaluate current practice use of laparoscopic and minimally invasive therapies in the treatment of renal cell cancer.
  
  
  METHODS
  A questionnaire was sent to 174 members of the Minnesota Urological Society. The first case scenario described a 6-cm lesion not amenable to nephron-sparing surgery. The second case scenario described a 3-cm lower pole exophytic mass amenable to nephron-sparing surgery. The treatment options included traditional therapy (open partial or radical nephrectomy) and minimally invasive therapy (laparoscopic radical or partial nephrectomy or renal cryoablation).
  
  
  RESULTS
  Our survey response rate was 49%. For the first scenario, 86% of respondents would offer open radical nephrectomy; however, 57% would offer laparoscopic surgery. Of those urologists offering laparoscopic surgery, 14% would refer outside their practice and 43% would use a hand-assisted approach. Sixty-four percent of the metropolitan and 56% of the urban respondents would offer a form of minimally invasive therapy; only 29% of rural respondents offered these options. For the second scenario, 90% of respondents would offer open partial nephrectomy and 45% a minimally invasive therapy; however, 24% of these would refer outside their practice. Thirty-eight percent of respondents would offer laparoscopic partial nephrectomy and 22% of respondents would offer renal cryoablation. Urologists completing residency after 1990 were more likely to offer a minimally invasive option (65%) compared with urologists completing residency before 1990 (31%).
  
  
  CONCLUSIONS
  Minimally invasive therapy for renal cell cancer is evolving into a community standard of care, with urologists relying heavily on outside referrals to access minimally invasive alternatives. Younger urologists living in metropolitan and urban areas are more likely to offer minimally invasive therapy. Additional emphasis should be placed on increasing the availability of minimally invasive techniques in rural settings.
authors.affiliation: Department of Urologic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Best
authors.forename: Barbara
authors.initials: B
authors.lastname: Ercole
authors.forename: Courtney
authors.initials: C
authors.lastname: Lee
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fallon
authors.forename: Jasón
authors.initials: J
authors.lastname: Skenazy
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods* / Q000523:psychology; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000523:psychology; D008910:Minnesota; D009392:Nephrectomy / Q000379:methods / Q000523:psychology / Q000592:standards*; D010820:Physicians / Q000523:psychology*; D012017:Referral and Consultation; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D014572:Urology