tailieunhanh - Surgery of nephron-sparing: Part 2

(BQ) Continued part 1, part 2 of the document Surgery of nephron-sparing has contents: Laparoscopic partial nephrectomy, nephron-sparing surgery in non-mitotic conditions – an overview, evaluation of energy sources used in nephron-sparing surgery, controversies in nephron-sparing surgery, and other contents. Invite you to refer. | 8 Laparoscopic partial nephrectomy Saleh Binsaleh and Anil Kapoor INTRODUCTION In 1991 Clayman et al described the first successful laparoscopic Since that time laparoscopic radical nephrectomy for renal tumors has been routinely performed in select patients worldwide. During this period elective open partial nephrectomy has established itself as an efficacious therapeutic approach in the treatment of small renal masses2 similar to that of radical nephrectomy in select patients with a small renal tumor. At the same time the widespread use of contemporary imaging techniques has resulted in an increased detection of small incidental renal tumors in which the management during the past decade has been trended away from radical nephrectomy toward nephron-conserving surgery. In 1993 successful laparoscopic partial nephrectomy LPN was first reported in a porcine model 3 while Winfield et al reported the first human LPN in From that time several centers in the world have developed laparoscopic techniques for partial nephrectomy through retroperitoneal or transperitoneal approaches. In the beginning only small peripheral exophytic tumors were wedge excised but with experience larger infiltrating tumors have been managed LPN combines the advances and benefits of nephronsparing surgery and laparoscopy to offer a decreased morbidity inherent to laparoscopy while preserving the renal function offered by partial nephrectomy. Technical difficulty in LPN is encountered when securing renal hypothermia renal parenchymal hemostasis pelvicalyceal reconstruction and parenchymal renorraphy by pure laparoscopic techniques. Nevertheless ongoing advances in laparoscopic techniques and operator skills have allowed the development of a reliable technique of laparoscopic partial nephrectomy duplicating the established principles and technical steps underpinning open partial nephrectomy. In this chapter we evaluate the role of LPN in the nephron-sparing .