USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Curr Opin Urol. 2010 Sep;20(5):365-70. doi: 10.1097/MOU.0b013e32833ce7dc.
As familiarity with laparoscopic partial nephrectomy (LPN) has grown, application has expanded into increasingly complex cases. In this review, we present a recent series describing use of LPN in specific clinical scenarios and describe common technical modifications commonly employed in each case. In addition, we discuss modifications to standardly performed maneuvers.
Partial nephrectomy was originally reserved for absolute indications and small peripheral masses. However, well tolerated utilization of LPN in larger and more complex tumors including those in hilar or central locations, in kidneys with multiple masses, and in patients with previous renal surgery have been described. Additionally, patients with comorbidities such as obesity, and anatomic variations including multiple renal vessels and solitary kidneys have also undergone LPN with success. Furthermore, modifications to standard techniques have helped improve perioperative characteristics, such as warm ischemia time, to levels comparable to open surgery. Although many of the LPN series are small, they represent the most recent novel applications of the technique.
LPN is a continuously evolving technique, and with case specific modifications can be safely performed in a wide range of clinical scenarios by sufficiently experienced hands.
随着腹腔镜部分肾切除术（LPN）的普及，其应用范围已扩展到越来越复杂的病例。在本次综述中，我们介绍了最近的一系列病例，描述了 LPN 在特定临床情况下的应用，并介绍了每种情况下常见的技术改良。此外，我们还讨论了标准操作的改良。
部分肾切除术最初仅适用于绝对适应证和小的外周肿块。然而，人们已经成功地将 LPN 应用于更大、更复杂的肿瘤，包括位于肾门或中央的肿瘤、多个肿瘤的肾脏、以及既往有肾脏手术史的患者。此外，患有肥胖等合并症，以及存在多个肾血管和孤立肾等解剖变异的患者也成功地接受了 LPN。此外，对标准技术的改良有助于改善围手术期的特点，如热缺血时间，使其达到与开放手术相当的水平。虽然许多 LPN 系列的病例数量较少，但它们代表了该技术的最新应用。
LPN 是一项不断发展的技术，通过具有特定病例的改良，由经验丰富的医生操作，可以安全地应用于广泛的临床情况。
