Minimally invasive treatment of small kidney cancer

  With the increasing maturity of laparoscopic technology, laparoscopic radical kidney cancer surgery has become increasingly popular in China. We were the first to carry out laparoscopic radical kidney cancer surgery in China, especially the laparoscopic surgery with transabdominal approach. At present, we have completed nearly 400 cases of laparoscopic radical kidney cancer surgery and kidney unit preservation surgery, and the proportion of minimally invasive surgery for kidney cancer is about 75%, which greatly reduces the pain of patients. In the long years of clinical practice, we have developed a series of technical features such as anatomical radical kidney cancer treatment via retrolaparoscopy, early and early renal artery blocking method for radical kidney cancer treatment via laparoscopy, and rapid renal tip dissection method via laparoscopy. The relevant papers were published in the Journal of Endourology, an international authoritative journal of intracavitary urology.  1.Propose the concept of early ligation of renal artery in transabdominal laparoscopic radical kidney cancer surgery The principle of tumor free in radical tumor surgery is the first principle that surgeons must follow. Transabdominal laparoscopic radical kidney cancer surgery has inherent advantages with large operation space and clear anatomical markings. However, because the renal artery is located behind the renal vein, when freeing the renal artery, it is often necessary to free the tumor sufficiently, which is not conducive to the tumor-free principle. We used early dissociation of the renal artery according to the vascular anatomical features, on the right side between the inferior vena cava and the abdominal aorta and on the left side posterior to the Treitz ligament. This is the beginning of the renal artery, with few branches and a fixed position. Once the renal artery is controlled, the superficial renal vein can be easily dissected and thus the tumor can be completely removed. The surgery has the characteristics of tumor-free, blood-free, and clear operative field. We have completed more than 80 cases, and the indexes of operation time, operation bleeding and transit opening are better than traditional methods.  2. Pioneering single-port laparoscopic nephrectomy and renal unit preservation surgery Since Rane et al. first reported single-port laparoscopic nephrectomy at the World Congress of Luminal Urology in 2007, this procedure has rapidly become a new technical highlight in urology. We performed the first such procedure in China in December 2008. We have completed more than 40 cases of various types of single-port laparoscopic surgery, including kidney unit preservation surgery (3 cases) and 8 cases of radical nephrectomy for kidney cancer, which was presented by Prof. Yinghao Sun at the 2009 National Congress of Urology and won an award. This surgery is less invasive and has good cosmetic effect, representing a new trend in minimally invasive treatment of kidney cancer, especially NSS surgery.  We are not only the first to carry out this type of surgery on a large scale in China, but also developed our own pre-curved single-port laparoscopic instruments and single-port access, and the related research results are being filed for patent. In addition, in order to promote this kind of surgery in China, we also summarize a set of cross-operating skills and design training models, which are at the leading level at home and abroad.  3. We are the first to carry out the research of endoscopic surgery through natural cavity (NOTES) NOTES surgery is a brand new field in the development of minimally invasive surgery, although it is still immature, the advantage of no scar attracts many scholars abroad. A large number of animal experiments are in progress, among which the nephrectomy surgery under NOTES is called “the third generation nephrectomy”. We are the first in China to carry out nephrectomy under NOTES, and have completed animal experiments such as transgastric and transcystic kidney biopsy and hybridized nephrectomy under NOTES. We also broadcasted nephrectomy under pure NOTES (animal experiments) live at the 30th International Congress of Urology in 2009 (more than 2000 foreign scholars attended). This marks that we have reached the world advanced level in this field.