Minimally invasive surgery for renal cell carcinoma

The oncologic principles of the surgical management of renal cell carcinoma (RCC) have remained essentially the same since first proposed by Robson in 1963. RCC remains a chemo- and radiation-resistant tumor; hence, surgical treatment is still the mainstay of curative therapy. Extirpative management of RCC via open radical nephrectomy (and later open partial nephrectomy) has been the standard of care for decades. With the advent of laparoscopic surgery and its intense application in urology in the early 1990s, a paradigm shift to minimally invasive renal surgery was initiated and has spurred an array of technologies, methods and procedures. Guidelines on the proper selection of patients and treatment modalities have been developed and established, allowing patients to benefit from better oncologic efficacy and reduced morbidity, and requiring urologic surgeons to master minimally invasive procedures alongside the techniques of open surgery. This review focuses on the minimally invasive management of RCC, discussing the advantages and disadvantages of laparoscopy, partial nephrectomy, probe ablation and newer treatment modalities. In order to provide material for this review, a search of the MEDLINE database was performed through January 2009 using the National Center for Biotechnology Information PubMed internet site to review the world literature regarding the minimally invasive treatment of RCC.