title: The future of partial nephrectomy.
abstract: Innovation in recent times has accelerated due to factors such as the globalization of communication; but there are also more barriers/safeguards in place than ever before as we strive to streamline this process. From the first planned partial nephrectomy completed in 1887, it took over a century to become recommended practice for small renal tumours. At present, identified areas for improvement/innovation are 1) to preserve renal parenchyma, 2) to optimise pre-operative eGFR and 3) to reduce global warm ischaemia time. All 3 of these, are statistically significant predictors of post-operative renal function. Urologists, have a proud history of embracing innovation & have experimented with different clamping techniques of the renal vasculature, image guidance in robotics, renal hypothermia, lasers and new robots under development. The DaVinci model may soon no longer have a monopoly on this market, as it loses its stranglehold with novel technology emerging including added features, such as haptic feedback with reduced costs. As ever, our predictions of the future may well fall wide of the mark, but in order to progress, one must open the mind to the possibilities that already exist, as evolution of existing technology often appears to be a revolution in hindsight.
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom. Electronic address: theo.malthouse@doctors.org.uk.
authors.forename: Theo
authors.initials: T
authors.lastname: Malthouse
authors.affiliation: University College London Hospital, 235 Euston Rd, Fitzrovia, London NW1 2BU, United Kingdom.
authors.forename: Veeru
authors.initials: V
authors.lastname: Kasivisvanathan
authors.affiliation: King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Raison
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom.
authors.forename: Wayne
authors.initials: W
authors.lastname: Lam
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Challacombe
mesh_terms: D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods* / Q000639:trends*; D015641:Radiography, Interventional / Q000639:trends; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends*; D016896:Treatment Outcome
keywords: Future; Partial nephrectomy; Robotic partial nephrectomy