Laparoscopic radical nephrectomy

Although open nephrectomy is the standard of care for localized renal-cell carcinoma, the significant postoperative pain and lengthy convalescence hav e encouraged the use of laparoscopy, which can yield similar 2- to 5-year s urvival rates, Either a transperitoneal or a retroperitoneal approach may b e used, and sometimes, they are combined. Generally, the technique is limit ed to tumors <10 cm, but larger tumors can be removed, Nitrous oxide is avo ided as an anesthetic agent. The dissection follows accepted oncologic prin ciples: in situ renal dissection within Gerota's fascia, early ligation of the renal vessels, and careful removal of the specimen to prevent tumor spi llage. Dissection of the hilum is facilitated by a PEER retractor and an En doholder. On average, patients having laparoscopic radical nephrectomy retu rn to normal activities approximately 4.5 weeks sooner than those having op en surgery, a fact not taken into account in cost analyses, Laparoscopic ne phrectomy may offer a special benefit in patients with known metastatic dis ease, as interleukin-2 administration can be started a month earlier than a fter open surgery, There may also be immunologic benefits of minimally inva sive <nu> open surgery. The technique and instruments continue to evolve, a nd cost-effectiveness should continue to improve.