Medical Conferences

Any surgery has to be planned taking into consideration both the pathology to be treated as patient characteristics.

Until the decade of the 90 conventional surgery in renal adenocarcinoma was radical nephrectomy, which involves the removal of Gerota’s fascia and its contents the kidney, perirenal fat and adrenal tumors whether it was upper pole.

Still in dispute has been whether or not to perform regional lymphadenectomy latero-caval chains in the right side and latero-aortic left, due in part to poor prognosis when lymph node and also clear the lymphatic drainage of renal tumors is variable and may reach different areas of the retroperitoneum and even the mediastinum.

The surgical approach depends more on personal preference than simply surgical or oncology criteria. There was a time where I was almost banned the retroperitoneal and transabdominal is advocated as the approach that met the most rigorous oncological premises, avoiding the manipulation before clamping the renal pedicle.

Today is no longer as strict and can address both renal tumors by trans and retroperitoneal, mainly if they are not excessively large and especially if there is no venous vascular involvement. Route would brake-thoraco-abdominal reserved for large tumors of the upper pole and those with thrombosis of the vena cava above the kidney and where it is necessary to control the supradiaphragmatic vena cava. In the early 90s starts another revolutionary change as far as renal surgery is concerned, we refer to laparoscopic surgery.

Clayman performed the first successful laparoscopic nephrectomy via transperitoneal 1990 in atrophic kidney, surgery performed in our country Rioja in 1992. Gaur later described the laparoscopic retroperitoneal 1992 and Hernandez held in Spain, the first nephrectomy in this way in 1994. Yet this analysis is not of age until, about the end of the twentieth century, laparoscopy demonstrates its role and benefits in the treatment of renal cancer, are now more and more groups and thus their publications where demonstrate the reliability of the technique, their results in terms of curing the disease and its advantages in relation to morbidity that condition.

The groups experienced radical nephrectomy, nephroureterectomy, partial nephrectomy and lumpectomy with very competitive operating times, shorter surgical stays and faster return of patients to their normal environment.