Laparoscopic renal surgery: The bar continues to rise

In 2006, there seem to be few new hurdles to climb in laparoscopic extirpative renal surgery or, for that matter, even laparoscopic reconstructive procedures. These high standards do come at a price, as learning curve complications are often unavoidable, regardless of the skill or experience of the surgeons. There is no denying the global trend toward laparoscopic and minimally invasive renal surgery and the rapid acceptance of laparoscopic partial nephrectomy at many larger metropolitan centers.

Two articles in this issue of Urology Times focus on important aspects of laparoscopic partial nephrectomy.

This report offers technical caveats along with extensive results and complications, all of which provide invaluable insight. The importance of strong skills in laparoscopic suturing and the use of biologic hemostatic agents are most notable, in my opinion.

Osamu Ukimura, MD, and associates, also from the Cleveland Clinic, reported on a subset of laparoscopic partial nephrectomy patients, those with pT2 and pT3 tumors. In this study, a nonblinded radiologist could not predict the presence of tumor invasion in the perirenal fat using CT scan. The researchers conclude that excision of the overlying perirenal fat be performed in higher-risk lesions. Certainly, this report speaks to the importance of maintaining sound oncologic principles when performing laparoscopic oncology.

In the end, the real winners should be our patients, who rightly seek optimal cancer treatment with minimal morbidity. And while select centers of excellence have led the way for urologists worldwide in renal laparoscopy, practicing urologists as a whole must stay close to the cutting edge of laparoscopic renal surgery in order to ensure urology's dominance in the management of renal tumors.