Laparoscopic Radical Nephrectomy

Laparoscopic radical nephrectomy is performed under general anesthesia. The duration of the surgery may vary between individuals, but on average, it takes approximately 3 to 4 hours.

During the procedure, the surgeon makes 3 to 4 small incisions (less than 1 cm each) in the abdomen. These incisions provide access for a laparoscope (a telescope) and specialized surgical instruments, which are inserted through small portals called trocars. The trocar configuration for the laparoscopic procedure forms a triangular shape, with the top two being yellow and green, and the bottom one being blue. Yellow dotted lines are drawn from the top two trocars.

The laparoscope provides 10X magnification of the surgical area, which allows the surgeon to perform the surgery with enhanced visualization, without directly placing hands inside the abdomen. Carbon dioxide gas is introduced into the abdomen to create more space for the surgeon to work. This gas is removed at the end of the surgery.

The surgeon then dissects and exposes the affected kidney by carefully separating it from surrounding organs, such as the liver, spleen, and intestines. The blood vessels supplying the kidney are clipped and divided, enabling the safe removal of the kidney with minimal blood loss. If necessary, the tumor, surrounding fat, and nearby lymph nodes are also removed. In some cases, the adrenal gland may be removed if the tumor is large or near it. Once the kidney and tumor are removed, they are placed in a plastic bag and extracted through one of the pre-existing incisions. Finally, the incisions are closed using advanced plastic surgery techniques to minimize scarring.

Laparoscopic Partial Nephrectomy (LPN)

Laparoscopic partial nephrectomy (LPN) offers significant advantages over traditional open nephron-sparing surgery (NSS) for kidney tumors, particularly in terms of oncologic outcomes and surgical principles. Studies show that LPN provides similar oncologic efficacy and superior renal function outcomes when compared to laparoscopic radical nephrectomy (LRN). The main benefits of LPN include reduced blood loss, less pain at the surgical site, quicker recovery, improved cosmetic results, and better preservation of kidney function.

This review article examines the literature on LPN and outlines the main surgical steps, perioperative management, potential complications, and its role in the treatment of kidney tumors.