According to the theory of Chinese medicine, the kidneys are the “essence of nature”, storing the “essence” needed for human growth and development, and its importance is evident. As research progresses, people understand more and more about the role of the kidney, which is not only the “filter” of the human body (to ensure the timely removal of body wastes and maintain the balance of water and electrolytes), but also the “regulator” of blood and bone system metabolism (involved in the production of red blood cells and calcium and phosphorus metabolism). Participates in the production of red blood cells and the metabolism of calcium and phosphorus). Undoubtedly, the kidneys are a vital part of the human body. It is well known that the human body has two kidneys, which are like twins, located on both sides of the spine in the abdominal cavity. Under normal circumstances, they undertake equal amounts of work, perform physiological functions together, and have a 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 plagued by two major problems: on the one hand, the healthy kidney will age faster because of the increased burden; on the other hand, the post-operative isolated kidney also contains a great deal of uncertainty, once the renal function is not compensated by the lesion of the healthy kidney again, patients 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. At present, partial nephrectomy is mainly used in the treatment of kidney cancer. The following author will take kidney cancer as an example to briefly explain the process of people’s understanding of partial nephrectomy. In the early stage, radical nephrectomy has been the gold standard of kidney cancer treatment due to 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 surgical scope. 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 also been promoted due to the increasing public health awareness and the development of imaging technology. At present, more than 50% of kidney cancers are detected by physical examination and are incidental cancers (early renal cell carcinoma found by chance). The size of kidney cancer at this stage is relatively small, and if the tumor grows exophytically, it often has the conditions for partial nephrectomy. Under such circumstances, the author believes that laparoscopic partial nephrectomy should be the preferred treatment for patients. In the following, I will focus on laparoscopic partial nephrectomy from three aspects. Indications for laparoscopic partial nephrectomy Similar to open partial nephrectomy, the main indications for laparoscopic partial nephrectomy are early renal cell carcinoma (tumor confined to the kidney, diameter less than 4 cm) and renal vascular smooth muscle lipoma (commonly known as renal malformation tumor). Renal vascular smooth muscle lipoma is a benign lesion, and the use of partial nephrectomy and complete removal of the lesion can prevent the serious consequences of tumor bleeding and completely cure this disease. In contrast, early 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 cancer that is confined to the kidney and has a diameter of 4-7 cm. 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 lead to 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 the very deteriorated renal function after surgery would be a greater threat to the patient’s life than the renal cancer itself. Other lesions that are suitable for laparoscopic partial nephrectomy include benign lesions such as segmental renal vascular malformations, duplicated renal malformations with poor drainage, limited renal injury with bleeding and urinary extravasation, specific and nonspecific infections that cannot be controlled with antibiotics, and multiple stones confined to the upper or lower pole of the kidney. Regardless of the type of lesion, the choice of laparoscopic technique is determined by both the tumor itself and the operator. Benign tumors that are small in extent and located close to the periphery of the kidney are best suited for laparoscopic partial nephrectomy. If the tumor condition is more complex, the operator’s experience and technique will play a key role. The advantages of laparoscopic partial nephrectomy Similar to open partial nephrectomy, laparoscopic partial nephrectomy completely replicates the steps of open surgery, whether benign or malignant lesions, but the reason why laparoscopic partial nephrectomy can gradually replace open surgery is mainly due to its unique advantages, which will be introduced by the author from four aspects: 1), laparoscopic partial nephrectomy Laparoscopic partial nephrectomy does not require a large incision of the abdominal wall and open exposure of the abdominal organs, the operation only requires the opening of three small holes of about 1 cm in the abdominal wall for the passage of lumpectomy instruments. This surgical approach allows for a much smaller skin incision and a much shorter postoperative skin closure time than in open surgery. If the conditions are good, the skin wound can even be bonded with adhesive to avoid suture reaction and stitch removal, resulting in a more aesthetic skin wound, faster healing, and shorter hospital stay. With the continuous development of minimally invasive concepts and techniques, recently there is even a single-hole laparoscopic technique, in which all surgical instruments enter the abdominal cavity through a single orifice, which makes the skin trauma further reduced. However, single-port technology requires higher surgical techniques and has not yet gained popularity; 2), the small size of laparoscopic surgical instruments, just a small lens and two joysticks into the abdominal cavity is sufficient to complete the operation, reducing the space occupied by the operator’s hand in open surgery. This effect not only reduces the damage to the normal anatomical structure of the abdominal cavity and reduces the incidence of postoperative tissue and organ adhesions, but also avoids excessive intraoperative trauma, which reduces the patient’s intraoperative stress response (such as stress ulcers) and relatively diminishes postoperative pain; 3), laparoscopic surgery requires continuous pumping of carbon dioxide gas into the abdominal cavity to expand the operating space and make the surgical field clearer and the operation more convenient. In addition, the pumped gas raises the intra-abdominal pressure, making the pressure difference between inside and outside the intra-abdominal arteriovenous wall narrow, reducing venous blood leakage and greatly reducing intraoperative bleeding; 4), the laparoscopic camera can magnify the visual object 10-12 times, which is equivalent to an additional magnifying glass than open surgery. This magnification effect makes the fine structure of tissues and organs show more clearly and more easily discernible. It not only makes the location of lesion edges clearer, but also reduces unnecessary damage to other organs during surgery. With its help, the operator’s surgical operation can be more precise and detailed, and the incidence of intraoperative complications is much lower than that of open surgery. Through the above introduction, we found that laparoscopic partial nephrectomy has obvious advantages, but laparoscopic partial nephrectomy also has its limitations. Due to the long laparoscopic instruments and the fact that the operating technique is completely different from that of open surgery, especially in case of emergencies (e.g. bleeding), it will rely more on the surgeon’s experience and skill to perform skilled operation and timely management. Therefore doctors often need special training and patients often have to seek help from experienced doctors at large tertiary hospitals. Complications of laparoscopic partial nephrectomy With all the benefits mentioned, there is actually a possibility of complications with laparoscopic partial nephrectomy, mainly including bleeding, infection, renal insufficiency, and urinary fistula and urinary leakage, but the chance of these complications will be greatly reduced if preoperative comprehensive evaluation and management are done and a surgeon with rich experience and solid surgical skills is chosen. Through the above introduction, readers must have further knowledge about laparoscopic partial nephrectomy. Currently, laparoscopic partial nephrectomy is mainly used for the treatment of benign and malignant lesions such as early renal cell carcinoma and renal vascular smooth muscle lipoma, and is gradually being 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. These operations are difficult, and the surgical procedure is more dependent on the surgeon’s experience and technique, and there is also the possibility of complications, therefore, readers need to look at it objectively. It is believed that with the continuous research and practice, the applicability of laparoscopic partial nephrectomy will be further expanded, the incidence of complications will be gradually reduced, and more patients will benefit from it.