Contemporary minimal-invasive nephron-sparing surgery

To assess the current status and future perspectives of minimal-invasive nephron-sparing surgery (NSS) including extirpative and ablative techniques. Minimally invasive nephron-sparing surgery for renal tumors comprises extirpative laparoscopic partial nephrectomy (LPN) and ablative procedures such as cryoablation, radiofrequency ablation, as well as radiosurgery. Minimally invasive nephron-sparing surgery modalities offer reduced morbidity as compared with open partial nephrectomy. Recent trials comparing laparoscopic partial nephrectomy and open partial nephrectomy demonstrated equivalent cancer-specific survival. Encouraging long-term data are becoming increasingly available for laparoscopic partial nephrectomy and cryoablation. However, some concerns remain about incomplete tumor cell kill after radiofrequency ablation. Radiosurgery is a promising new technology, but is still experimental. The increasing availability of robotic assistance in urologic oncology also allows for novel therapeutic concepts such as single-port laparoscopy. Open and laparoscopic partial nephrectomies are the standard-of-care for treating small renal masses, with LPN becoming the preferred option in high-volume urooncology centers. Continuing research adds to the value of ablative technologies.