Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
Curr Opin Urol. 2021 May 1;31(3):255-261. doi: 10.1097/MOU.0000000000000862.
Nephron-sparing partial nephrectomy is the state of the art for localized small renal mass and it is gaining attention also for more advanced cases. In the present narrative review, we discuss the new developments that have occurred in the advancement of this approach over the past few years.
Off-clamp, selective/superselective clamp and early-unclamping techniques are safe and feasible approaches, with potentially superior functional outcomes, and noninferior complications rate and oncological outcomes, when compared with main artery clamping. Renorrhaphy must preserve the physiological vascularization of residual parenchyma. Running sutures, particularly using barbed wires, shorten the operating and ischemia times. A further advantage could derive from avoiding a double-layer suture. Transperitoneal robot-assisted partial nephrectomy (RAPN) and retroperitoneal RAPN can be considered equivalent in terms of perioperative morbidity, functional and oncologic outcomes, regardless of tumor's location, thus the choice of the approach should be driven by the surgeon's expertise. Future improvements should be introduced by the single-port robotic surgery, which seems to be safe and feasibly also in an off-clamp manner.
Significant advances have recently been achieved in nephron-sparing surgery technique. However, future studies with standardized reporting of these new techniques are needed to assess the real impact of them on early and long-term functional outcomes.
保肾单位肾部分切除术是治疗局限性小肾癌的金标准，而且对于更晚期的病例也越来越受到关注。在本叙述性综述中，我们讨论了过去几年中在该方法的发展中出现的新进展。
无夹闭、选择性/超选择性夹闭和早期夹闭技术是安全可行的方法，与主动脉夹闭相比，具有潜在更好的功能结果，并发症发生率和肿瘤学结果无差异。肾缝合必须保留残留肾实质的生理性血管化。连续缝合，特别是使用带刺缝线，可以缩短手术和缺血时间。避免双层缝线可能会带来进一步的优势。经腹腔机器人辅助部分肾切除术（RAPN）和经腹膜后 RAPN 在围手术期发病率、功能和肿瘤学结果方面可以被认为是等效的，而与肿瘤位置无关，因此，手术方法的选择应取决于外科医生的专业知识。单孔机器人手术可能会带来显著的改进，它似乎也是安全且可行的，甚至可以采用无夹闭方式。
保肾单位肾部分切除术技术最近取得了重大进展。然而，需要对这些新技术进行标准化报告的未来研究来评估它们对早期和长期功能结果的真正影响。
