POTENTIAL OF LAPAROSCOPY AND RETROPERITONEOSCOPY IN THE TREATMENT OF RENAL PARENCHYMAL TUMOURS
PART II - KIDNEY-SAVING PROCEDURES
Authors:
doc. MUDr. Milan Hora, Ph.D.; MUDr. Jiří Klečka
Authors‘ workplace:
Urologická klinika LF UK a FN Plzeň
Published in:
Urol List 2005; 3(3): 35-41
Overview
Objective, methodology: An overview of minimally invasive kidney-saving laparoscopic methods in the treatment of renal tumours. An overview of current state of knowledge published in relevant literature is complemented with the authors' experience in the introduction of the above techniques in their practice in the University Hospital of Pilsen.
Results:
Two basic techniques are applied in kidney-saving procedures. The first technique simulates open resection involving clamping of the hilus and suture of resected kidney with intracorporeal knotting. This method is technically more demanding and requires higher skills in laparoscopic surgery. The other technique uses cryoablation and thermoablation (especially radiofrequency) to destroy the tumour which is left in situ, or to allow for bloodless tumour resection without clamping the hilus. The above techniques are easier to reproduce but more expensive and demanding in terms of technical equipment, and involve the risk of part of the tumour remaining vital. Research to discover the best physical principle and to develop the best apparatuses is still under way. The two methods are likely to become part of routine practice only after their further elaboration and a longer-term assessment of oncological results.
Conclusion:
Laparoscopic saving procedures for renal tumours represent a recently introduced method which is still in a development stage and cannot be recommended indiscriminately for routine clinical practice. Open resection procedures are therefore still acceptable as the golden standard. Nevertheless, the validity of the above statement is sure to diminish in favour of the laparoscopic method in the years to come.
KEY WORDS:
laparoscopy, retroperitoneoscopy, renal tumour, partial nephrectomy, resection, cryoablation, radiofrequency ablation
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