Nephron Sparing Surgery with the Ultrasonic Scalpel

Abstract

Surgical resection remains the cornerstone of treatment renal cell carcinoma. In the last 15 years a better understanding of tumor biology and the early diagnosis permitted an evolution of the surgical treatment towards a minimal invasive approach by nephron-sparing surgery. Together with absolute and relative indications, nephron-sparing surgery is performed also as an elective indication, in patients with small, localized, often incidental tumors and a normal controlateral kidney. The oncological outcome in these cases is identical with that of radical nephrectomy. In order to achieve a complete tumor resection with the maximal preservation of unaffected renal parenchyma, tumor enucleation is the best technique when feasible. With the use of the harmonic scalpel, clamping of the renal pedicle and renal ischemia can be avoided in most of the cases during enucleation of small tumors, while the thermal damage in the remaing renal parenchyma is minimal.