Partial nephrectomy - Contemporary indications, techniques and outcomes

Increased detection of the small renal mass over the last two decades has led to greater utilization of partial nephrectomy techniques. Appreciation of the negative impact of chronic renal impairment has resulted in partial nephrectomy surpassing radical nephrectomy as the preferred treatment for technically feasible lesions. Indeed the management of localized renal tumours has become focused on techniques that maximally preserve nephron quantity and quality, and therefore maximize renal function after surgery. Postoperative renal function is determined primarily by three factors: preoperative renal function, volume of renal mass preserved and surgical renal ischaemia. Minimization of surgical ischaemia is achieved by early unclamping and unclamped (zero ischaemia) techniques. In addition, laparoscopic and robotic approaches to nephron-sparing surgery have significantly reduced the morbidity of the partial nephrectomy procedure compared with the traditional open approach. The contemporary techniques used for partial nephrectomy demonstrate excellent renal functional and oncological outcomes and minimize perioperative complications.