The first laparoscopic nephrectomy was performed by Clayman and colleagues in 1990. Since then, laparoscopic nephrectomy for symptomatic benign renal pathology has been performed at multiple institutions throughout the world. Based on the excellent results of laparoscopic simple nephrectomy for benign pathology, laparoscopic radical nephrectomy for renal cell carcinoma is being carefully studied at select centers. Current experiences at these institutions suggest that, in comparison with open surgery, laparoscopic radical nephrectomy allows a technically adequate operation with decreased patient morbidity while affording equivalent cancer control over the intermediate term. At these select institutions, including the author's center, laparoscopic radical nephrectomy is rapidly emerging as a preferred treatment alternative in patients with medium-sized (up to 8 cm) renal tumors. Laparoscopic radical nephrectomy can be performed by the transperitoneal or retroperitoneal approach.

This article attempts to place the status of laparoscopic radical nephrectomy in perspective. The laparoscopic technique, including patient preparation, positioning, instrumentation, and technical nuances, is presented. After evaluating the worldwide results and complications of the transperitoneal and retroperitoneal laparoscopic approaches, a brief overview of the perceived advantages and disadvantages of each approach is outlined. The pros and cons of morcellation versus intact extraction of the kidney with renal cell carcinoma are discussed. The intermediate-term oncologic efficacy of laparoscopic radical nephrectomy is evaluated and the author's perspective on the future role of this technology presented.