Radical Nephrectomy for Renal Cell Carcinoma: Non-robotic Minimally Invasive Approaches

Over the past 150 years, the nephrectomy has undergone multiple changes, including the adoption of radical extirpation (including removal of the peri-renal fat and Gerota’s fascia) in the 1960s given the demonstrated improvement in oncologic outcomes. Since the initial report in 1991, the laparoscopic approach to radical nephrectomy has been widely adopted for complete kidney removal given its improved post-operative recovery as compared to open surgery. Over the past 30 years, multiple other minimally invasive approaches have been developed utilizing the fundamental concepts of the initial procedure. Each new method has purported an advantage relative to the original. The most adopted of these newer techniques include the hand-assisted approach, which allows for palpation of the tissue as well as use of finger dexterity for wider retraction, and retroperitoneal, which avoids the needs for peritoneal access altogether. Others, such as single-site and natural orifice surgery, have shown improved cosmetic outcomes, but have not been widely adopted given the increased technical demands of the procedure. In this chapter, we aim to review the non-robotic, minimally invasive options to performing a radical nephrectomy in the treatment of renal cell carcinoma.