Evaluation of energy sources used in nephron-sparing surgery

The increasingly available use of improved abdominal imaging modalities has led to the rise in the incidental detection of small renal tumors by almost 60%.1 Historically, the mainstay of treatment for localized renal cell carcinoma (RCC) has been radical nephrectomy. However, nephron-sparing surgery (NSS), in particular open partial nephrectomy, has been shown to be equivalent to open radical nephrectomy in both local cancer control and overall survival, for solid renal masses less than 4 cm in size.2-4 In addition to partial nephrectomy, needle ablative techniques are particularly useful in treatment of small renal masses, in patients where medical comorbidities may preclude major surgery. The use of energy sources in the management of renal masses has taken on an integral component in the treatment of renal masses in NSS. Firstly, the use of varying energy sources to aid in renal dissection and maximize hemostasis in laparoscopic NSS. Secondly, the adaptation of various energy sources in minimally invasive ablative techniques in the treatment of small renal masses, in patients who may not be suitable for major surgery. This chapter will explore and evaluate the use of various energy sources in these two domains in the treatment of renal masses in NSS.