Laparoscopic radical nephrectomy is being applied in two new areas: cytoreductive surgery and tumors with renal vein and small inferior vena caval thrombi.

Walther et al. first noted that patients undergoing laparoscopic cytoreductive surgery for renal cell carcinoma came to be treated nearly 30 days earlier than patients who had traditional open procedures (40). Mosharafa et al. also reported similar findings (41).

In another area, to date, nine cases of laparoscopic treatment of patients with T3b (renal vein involvement) have been successfully undertaken; blood loss has averaged 350 cc with a 3.3-hours operative time and a 2.3-day hospital stay (42-45). Indeed Sundaram et al. have recently reported treating a small inferior venal caval thrombus laparoscopically (46).

To date, a subhepatic thrombus with cavotomy has not been done laparoscopi-cally; but it is likely only a matter of time before this is accomplished, as laparoscopic radical nephrectomy with level II vena caval thrombectomy has been reported in an experimental porcine model (47).

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