ABSTRACT
Since its introduction in 1991 by Clayman et al1
laparoscopic radical nephrectomy has rapidly become the standard of care for the treatment of most patients with localized renal tumours.2-4
Classically, radical nephrectomy was peformed openly after the original description by Robson et al in 1963.5 Following Robson’s principles of oncological renal surgery Gerota’s fascia was removed including perinephric fat to achieve adequate margins. Handling of the specimen before ligation of renal artery and vein was avoided in order to minimize the risk of tumour emboli. Much has changed since then and the drive to preserve maximal renal function coupled with the excellent oncological outcome of open and laparoscopic partial nephrectomy in addition to a downward stage shift has cast some doubt on Robson’s principles in contemporary management of renal tumors.6-8 Taking into account some technical improvements in instrumentation and camera systems and increasing surgical experience, laparoscopic radical nephrectomy has been established as the low morbidity, minimally invasive alternative to open radical nephrectomy with comparable oncological efficacy.2,3,9,10
As with most new surgical techniques, indications change with increasing surgical experience, advances in surgical technology and an
expansion of the surgeon’s ‘comfort zone’. Initially, only small renal tumours (T1-2 N0 M0) in patients with normal contralateral kidney were considered for laparoscopic radical nephrectomy,7 supported by 5-year outcome figures (Table 9.1).11
