Minimally invasive nephron-sparing surgery.
OBJECTIVE
To review the evolution and current status of minimally invasive nephron-sparing surgery for renal tumors.


RESULTS
Minimally invasive nephron-sparing surgery for renal tumors encompasses extirpative laparoscopic partial nephrectomy and ablative procedures such as cryoablation, radiofrequency ablation, and recently radiosurgery. Minimally invasive nephron-sparing surgery modalities are associated with decreased morbidity when compared with open partial nephrectomy. Recent multicenter study comparing laparoscopic partial nephrectomy and open partial nephrectomy demonstrated that equivalent cancer-specific survival was similar between the two modalities. Encouraging long-term data are available for laparoscopic partial nephrectomy and cryoablation. However, some concerns remain about incomplete tumor cell kill after radiofrequency ablation. Radiosurgery is a promising new technology, but is still experimental.


CONCLUSIONS
In 2008, open partial nephrectomy and laparoscopic partial nephrectomy are the reference standards for treating the small renal mass, with laparoscopic partial nephrectomy increasingly becoming the preferred option at major tertiary referral centers. Encouraging long-term data for ablative technologies are emerging.
Berger
Andre
A
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Crouzet
Sebastien
S
Canes
David
D
Haber
Georges-Pascal
GP
Gill
Inderbir S
IS
D002292:Carcinoma, Renal Cell / Q000601:surgery*; D017115:Catheter Ablation; D003452:Cryosurgery; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy / Q000379:methods*; D016634:Radiosurgery; D012371:Robotics