ABSTRACT
The indication for laparoscopic tumor nephrectomy for small renal masses (< 4 cm) has changed during the last decade and is similar to that for the open approach. To date organ-preserving techniques should always be preferred if possible and the laparoscopic procedure has replaced the open approach in many centers. Renal masses up to 4 cm can be treated with the laparoscopic approach; in some cases even larger tumor masses can resected laparoscopically, depending on the localization. Therefore, indication should be strict and the surgeon should be well experienced with laparoscopic procedures. This chapter describes our technique for laparoscopic partial nephrectomy in warm ischemia with endo-bulldog clamps using a thrombin-gelatin matrix for hemostasis. Major issues of laparoscopic partial nephrectomy are ischemia and hemostasis. As a bloodless operating field is crucial for proper resection, hilar clamping is advised in most cases.
