Although radical nephrectomy is the mainstay in the surgical management of renal cell carcinoma (RCC), a solitary kidney with RCC is an imperative indication for nephron-sparing surgery (NSS). In this rare setting, radical nephrectomy can potentially render the patient anephric, leading to dialysis or renal transplantation. Although open surgery is still the gold standard for NSS, there has been an upsurge in the number of minimally invasive NSS procedures that have demonstrated excellent long-term oncologic, surgical, and functional outcomes. Complex renal tumors in the setting of a solitary kidney add an additional challenge to minimally invasive NSS. Here we describe 3 complex cases of RCC in a solitary kidney treated successfully by video-assisted minilaparotomy surgery-NSS.
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