LPN, robotic RP stretch the surgical envelope

May 15, 2006

Urologists should begin to assess whether ablative techniques forsmall renal tumors are feasible within their own practiceenvironment.

Here is a brief overview of what to expect in these three areas.

LPN refinements

Although studies show that, nationally, clinical practice patterns regarding the adoption of laparoscopic renal surgery are slow to change, select centers continue to set the standard for minimally invasive therapies. Just as laparoscopic radical nephrectomy has achieved stability as a strong option for many renal tumors, LPN now appears to be a reproducible technique.

Ablation techniques expand

A number of centers are reporting longer-term data on the use and outcomes of laparoscopic and percutaneous cryoablation and radiofrequency ablation in the treatment of renal tumors.

At this year's meeting, select centers will demonstrate that ablative approaches can be used effectively in treating smaller renal tumors, although the specific approach, ablation modality, and lesion size parameters remain open to debate. Regardless, the use of image-guided therapies for renal tumors has arrived at many centers nationally.

Although performing renal ablative therapy may require a multidisciplinary team and may be impractical in certain practice environments, practicing urologists should begin to assess whether these treatments are feasible within their own practice setting.

Acceptance of robotics

The robotic approach to prostatectomy continues to gain acceptance throughout numerous centers, with consistent results. As recognition of the merits of robotic prostatectomy grows, so must the capacity to train physicians to use this technique competently and confidently. Look for newer alternatives in surgical simulation, including the use of training platforms specifically designed for urologists to create and maintain skills in laparoscopy.

Concepts such as the "mini-residency" will further clarify the tasks necessary to engage in ongoing training in urologic laparoscopy. As residencies achieve proper volumes to train outgoing residents in laparoscopy, the next phase of development will be in the area of ongoing "maintenance of skills."

If you want to stay abreast of developments in the field, the laparoscopy sessions at this year's AUA annual meeting present an important opportunity to learn from thought leaders in this exciting discipline.