Laparoscopic radical nephrectomy: morcellate or leave intact? Leave intact

At specialized centers worldwide, laparoscopic radical nephrectomy is now routine practice for management of indicated patients with localized renal cell carcinoma. Although the various intraoperative technical steps and maneuvers have been standardized for both the retroperitoneal and the transperitoneal laparoscopic approaches, controversy persists regarding the method of extraction of the nephrectomized cancerous specimen. Opinion is divided between intact extraction and morcellation. Clearly, the larger skin incision used for intact extraction is a cosmetic compromise. However, available data suggest that patient morbidity is not adversely impacted to any significant degree. Intact specimen extraction does build confidence into this procedure by respecting scientifically established oncologic guidelines, and it provides a specimen identical to that obtained in open surgery. This facilitates accurate pathologic staging, including assessment of surgical margins, which allows formulation of individualized, patient-specific follow-up protocols. For these reasons, intact extraction for renal cell cancer is preferred at our institution and multiple others worldwide.