[Role of laparoscopy in the presence of a renal mass under 4 cm in size].
The increasingly common incidental diagnosis of small renal masses (SRMs) (measuring under 4 cm in size) has led to the consideration of applying minimally invasive techniques to deal with them--particularly in view of the high percentage of non-malignant conditions of this size that are radiologically indistinguishable from tumor lesions. Accordingly, laparoscopic access has gained great importance in the management of these masses, in an attempt to lessen the morbidity associated with lumbotomy. Laparoscopic partial nephrectomy (LPN) is an evolving technique in most centers; on one hand it competes with open partial nephrectomy as the technique of choice, and on the other it will compete in the future with the non-excisional management techniques. These latter procedures in turn have become more precise thanks to laparoscopy. Based on a standardized review of the abundant literature on the treatment of SRMs, the present study examines the technical innovations and improvements afforded by the laparoscopic approach, not only for excision purposes but also a vehicle for minimally invasive treatments. Likewise, the requirements of Services of Urology and the improvements that could be introduced in health systems for advancing the application of LPN in the management of SRMs are commented. Progressive fine-tuning of the technique, with improvement of the laparoscopic repertoire and availability of hemostatic agents, will contribute to increase the indications for LPN in the future. The limited frequency of the disorder and the need to optimize the technique will require health care supervisors to centralize this type of pathology in centers with experience in laparoscopy and open partial nephrectomy.
Rubio Briones
José
J
Instituto Valenciano de Oncología, Valencia, España. jrubio@fivo.org
Estébanez Zarranz
Javier
J
Domínguez Escrig
J L
JL
D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D009392:Nephrectomy / Q000379:methods*