Kidney cancer, also known as renal cell carcinoma and renal adenocarcinoma, originates from the urinary tubular epithelium. Kidney cancer accounts for about 80%-90% of adult malignancies and is the most common kidney tumor in adults. The ratio of male to female is about 2:1, and it can be seen in all age groups, with a high incidence at the age of 50-70. With the increasing awareness of public health and the development of imaging technology, more and more early kidney cancers (incidental cancer) have been diagnosed in time. According to the theory of Chinese medicine, the kidney is the “innate essence”, which stores the “essence” needed for human growth and development, and its importance is evident. With the deepening of research, people understand more and more about the role of kidney, which is not only the “filter” of human body, removing waste in time and maintaining the balance of water and electrolytes in human body; but also the “regulator” of blood and bone system metabolism, participating in the production of red blood cells and calcium and phosphorus metabolism. It is the regulator of blood and bone system metabolism, participating in the production of red blood cells and calcium and phosphorus metabolism. There is no doubt that the kidneys are a vital part of the human body. What are the clinical signs and symptoms of cancer in the kidney? For many years, hematuria, pain and mass are called the “triad” of kidney cancer. About 40% of kidney cancer patients have visual or microscopic hematuria, and when a large amount of hematuria is formed with a blood clot, renal colic, painful urination, difficulty in urination, or even urinary retention may occur. When the tumor is large or located in the lower pole of kidney, the mass can be palpable, sometimes it is the only symptom; and the pain can have different manifestations, such as persistent dull pain when the tension of renal peritoneum increases or invades the surrounding tissues, dull pain or hidden pain when the tumor bleeds and causes subperitoneal hematoma, and persistent and severe low back pain when the tumor invades the adjacent tissues and organs, such as lumbar muscle or nerves. The incidence of pain is 20% to 40%. If you have related manifestations, you should consult a doctor in time to avoid delaying the disease. In fact, most of the patients with all the three signs at the time of consultation only account for about 10%, and often this is also the late stage of the tumor, rarely possible to cure. In clinical practice, more than 40% of kidney cancers are discovered accidentally due to health checkup or other reasons without obvious symptoms or signs, and their detection rate is increasing year by year, most of them are early lesions with good prognosis. Therefore, it is important to have regular medical checkups. In addition, 10% to 40% of patients develop paraneoplastic syndrome, which manifests as hypertension, anemia, weight loss, cachexia, fever, erythrocytosis, abnormal liver function, hypercalcemia, hyperglycemia, increased blood sedimentation, neuromuscular lesions, amyloidosis, overflow, and abnormal coagulation mechanism. Varicocele or dilated abdominal wall veins are present in about 2% to 3% of cases. About 10% of patients have symptoms such as bone pain, fracture, cough and hemoptysis due to tumor metastasis. Therefore, the clinical manifestations of kidney cancer are highly variable. With the above symptoms, one should consult a professional doctor and conduct the necessary related examinations in time. You should not take it for granted, and you should not take a chance. Only timely detection can lead to timely treatment. How to deal with tumor in kidney? As we all know, there are two kidneys in human body, they are like twin brothers, distributed in the abdominal cavity on both sides of the spine. Under normal circumstances, they undertake equal amount of work, complete physiological functions together and have certain reserve capacity. Even if one kidney is removed with lesions, if the other kidney functions normally, the kidney function can still be compensated in general. This part of patients can still live and work like normal people. However, these patients are troubled by two major problems: on the one hand, the healthy kidney will age faster due to the increased burden; on the other hand, the isolated kidney after surgery also contains a great uncertainty, if the healthy kidney has another lesion and the kidney function is not compensated, the patient will have to face the situation of kidney transplantation or hemodialysis. These two types of renal replacement therapy are not only extremely expensive, but also have a great impact on the quality of life of patients. What’s more unfortunate is that some patients have unsound basic kidney function on both sides, and if one kidney is removed, the kidney function will not be compensated. For them, it becomes especially important to preserve normal kidney tissue. Regardless of the above-mentioned patients, it is essential to adopt a treatment method that can both completely get rid of the lesion and effectively preserve the kidney function. Preservation of the renal unit, also known as partial nephrectomy, is one such procedure that fits these requirements perfectly. It can preserve the intact kidney tissue to the maximum extent possible and reduce the loss of kidney function when conditions permit. The advent of this treatment not only can relieve patients from the great distress caused by isolated kidney after surgery, but also can give a ray of hope to patients with insufficient kidney reserve capacity to avoid immediate dialysis or transplantation. In the early days, radical nephrectomy has been the gold standard of kidney cancer treatment, limited by the backwardness of people’s knowledge and research on kidney cancer. The standard radical nephrectomy requires removal of the complete kidney on the affected side and the ipsilateral adrenal gland, which is a large scope of surgery. Although the lesion removal is relatively complete, it often affects the long-term health quality of patients due to more loss of kidney function. Many patients die not from kidney cancer itself, but from renal failure and its associated multiple complications. This has prompted a search for a way to remove the lesion while preserving intact kidney tissue in the affected kidney. Large-scale clinical studies have been conducted for this purpose, and surprisingly, it has been found that partial nephrectomy can completely remove the kidney cancer lesion in some cases, and the tumor recurrence rate is comparable to that of radical nephrectomy. At the same time, the long-term quality of health of patients is rather better due to its less impact on kidney function. In this regard, partial nephrectomy has only been popularized and gradually developed. Partial nephrectomy has also undergone an evolution from open surgery to minimally invasive laparoscopy. Initially, open partial nephrectomy was the main surgical procedure, but in recent years, with the continuous advancement of minimally invasive concept and innovation of laparoscopic technology, laparoscopic partial nephrectomy has been accepted and recognized by more and more doctors and patients. It has to be admitted that laparoscopic partial nephrectomy has been promoted also due to the enhancement of public health awareness and the development of imaging technology. For early-stage renal cell carcinoma incidentally detected by physical examination, the tumor is relatively small in size and often has indications for partial nephrectomy, and laparoscopic partial nephrectomy should be the first choice of treatment for patients. Similar to open partial nephrectomy, the main indications for laparoscopic partial nephrectomy are early renal cell carcinoma (tumor confined to the kidney, less than 4 cm in diameter) and renal vascular smooth muscle lipoma (commonly known as renal malformation tumor). Renal vascular smooth muscle lipoma is a benign lesion, so partial nephrectomy can prevent the serious consequences of tumor bleeding and completely cure the disease by complete removal of the lesion. In contrast, early stage renal cancer is a malignant lesion, and some patients may worry that simply removing the tumor will increase the risk of recurrence. However, a large number of studies have confirmed that partial nephrectomy is comparable to radical nephrectomy in the treatment of early-stage renal cancer, with 5-year and 10-year survival rates of 98% and 92%, respectively, and a very low recurrence rate. In addition, recent large-scale clinical studies have demonstrated that laparoscopic partial nephrectomy can also be used for renal cancers that are confined to the kidney and are 4-7 cm in diameter. So far, its long-term prognosis has not been significantly different from that of radical surgery. It is worth mentioning that when kidney cancer is found on one side of the patient and at the same time the contralateral kidney suffers from benign diseases (such as kidney stones, chronic pyelonephritis, etc.) or there are other diseases that may cause deterioration of kidney function (such as hypertension, diabetes, renal artery stenosis, etc.), it is very meaningful to preserve its kidney unit. For this group of patients, partial nephrectomy should be used whenever conditions allow. For more specific patients, such as congenital isolated kidney, contralateral renal insufficiency or even non-functioning and bilateral simultaneous renal cancer, partial nephrectomy is an absolute indication for partial nephrectomy regardless of the size of renal cell carcinoma. This is mainly due to the fact that cardiovascular diseases brought about by very deteriorated renal function after surgery would be a greater threat to patients’ lives than kidney cancer itself. Regardless of the lesion, the choice of laparoscopic technique or traditional developmental surgery is mainly determined by both the tumor itself and the experience of the operator. If the tumor condition is complex, the experience and skill of the operator will play a key role. Compared with traditional open partial nephrectomy, laparoscopic partial nephrectomy replicates the operation steps of open surgery, but not simply. Laparoscopic partial nephrectomy can not only achieve the same tumor treatment effect as open surgery, but also has many advantages that open surgery cannot match: 1) Small surgical trauma and fast postoperative recovery, laparoscopic partial nephrectomy does not require large incision of the abdominal wall. The operation only requires the opening of four small holes of about 1cm in the abdominal wall for the passage of lumpectomy instruments. This surgical approach makes the incision much smaller, more beautiful, faster healing, shorter hospital stay and faster recovery; 2) the small size of laparoscopic surgical instruments, just a small lens and a few joysticks into the abdominal cavity is sufficient to complete the operation, reducing the space occupied by the operator’s hands in open surgery. This not only reduces the damage to the patient’s normal anatomy and the incidence of postoperative tissue and organ adhesions, but also avoids excessive intraoperative trauma and relatively less postoperative pain; 3) laparoscopic surgery adopts carbon dioxide pneumoperitoneum, which greatly increases the pressure inside the abdominal cavity and reduces the pressure difference between the inside and outside of the arteriovenous wall, which reduces venous blood leakage and greatly reduces intraoperative bleeding; 4) laparoscopic camera can magnify the visualization 10-12 times, which is equivalent to an additional magnifying glass than open surgery. This magnification effect makes the fine structures of tissues and organs show more clearly and easily discernible. It can not only clarify the location of the edge of the lesion, but also reduce unnecessary damage to other organs and bleeding during surgery. It makes the operator’s operation more precise and detailed, and the incidence of intraoperative complications is much lower than that of open surgery. Through the above introduction, patients must have a better understanding of laparoscopic partial nephrectomy. Currently, laparoscopic partial nephrectomy is mainly applied to the treatment of benign and malignant lesions such as early renal cell carcinoma (T1a) and renal vascular smooth muscle lipoma, and is being gradually extended to stage T1b renal cell carcinoma. Compared with traditional open partial nephrectomy, laparoscopic partial nephrectomy has unique advantages such as less trauma, faster wound healing, shorter hospital stay, less bleeding and more beautiful incision. However, laparoscopic partial nephrectomy requires the operator to complete the operation under the lumpectomy, including the suturing and ligation of the kidney, which is a difficult operation and depends more on the experience and skills of the surgeon. At present, our center has routinely carried out the minimally invasive technique of laparoscopic partial nephrectomy for early stage renal cancer. Laparoscopy is further divided into transabdominal and retroperitoneal routes, and compared with transabdominal, retroperitoneoscopic partial nephrectomy has more advantages. For urologists, the anatomical structure of the retroperitoneum is more familiar, and there are fewer tissues and organs, so the surgical operation will cause less interference with the abdominal organs, greatly reducing the damage to the gastrointestinal tract, liver, spleen, pancreas and other abdominal organs during the operation, less complications such as intestinal adhesions after the operation, and faster recovery of the patient’s intestinal function after the operation. Moreover, through the posterior abdominal cavity, the renal arteries can be freed more conveniently and safely, and even the renal artery branches supplying the tumor can be accurately located and separated in combination with preoperative CTA, and partial nephrectomy with super-selective renal segment artery block can be performed, thus achieving complete removal of the tumor while maximizing the protection of the patient’s renal function and reducing intraoperative bleeding. In addition, we are the first to apply thulium laser to laparoscopic partial nephrectomy, which greatly shortens the operation time and reduces intraoperative bleeding to almost zero. At present, our center has successfully performed laparoscopic partial nephrectomy with preservation of kidney units for hundreds of kidney cancer patients.