Laparoscopic extirpation of renal cell cancer: feasibility, questions, and concerns

Laparoscopic nephrectomy for benign disease has become an increasingly popular alternative to open surgery as more urologists gain confidence in their laparoscopic skills. However, the idea of laparoscopic extirpation of renal cell cancer caused significant concerns over the adequacy of surgical resection margins, trocar site seeding, and potential tumor spillage. The present chapter is the result of 5 year's experience with laparoscopic nephrectomy for renal tumor. To date, total and radical nephrectomies have been performed at Washington University in 20 patients; in each case, the appropriate surgical margins were obtained. Moreover, there have been, as yet, no instances of tumor spillage or delayed trocar seeding in our or others' experience. Furthermore, the immediate effectiveness of the procedure equals that of open radical nephrectomy; yet the hospital stay, patient discomfort, and convalescence are all markedly decreased. Only two drawbacks to the laparoscopic approach remain: 1) lengthy operative time, and 2) the increased cost associated with the prolonged operating room time. These problems will only be overcome by increased surgeon experience and further technological advances. Lastly, given the newness of the procedure, follow-up of these patients is still brief; however, results to date substantiate the hypothesis that laparoscopic radical nephrectomy is an effective, minimally invasive, long-term therapy for patients with localized renal cell cancer.