Laparoscopic radical nephrectomy for cancer.

Laparoscopic radical nephrectomy is a rapidly emerging technique for the treatment of renal cell carcinoma. Surgeons at multiple institutions have reported excellent technical results with this procedure, with encouraging safety and efficacy data and low complication rates comparable with the rates in open radical nephrectomy. Although debate continues regarding the pros and cons of the transperitoneal versus retroperitoneal approach and regarding morcellation versus intact specimen extraction, laparoscopic radical nephrectomy is beginning to approach standard-of-care status at select institutions for tumors less than 8 cm in size. Although generally accepted indications for laparoscopic radical nephrectomy include T1-T2N0M0 tumors, increasing experience and operator confidence have allowed expansion of these indications to include select patients with nodal disease, preoperatively staged level I renal vein thrombus, cytoreductive surgery before immunotherapy protocols, and the rare patient with a laterally directed locally invasive (pT4N0M0) renal cell carcinoma.