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Abstract Introduction: Renal Cell Carcinoma (Rcc) Approximately Accounts For 3% Of Adult Cancer And About 90-95% Of Renal Neoplasm (Kush Et Al., 2009). Over The Past Few Years, The Reported Incidence Of Rcc Has Risen At Accelerated Rate, In Large Part Due To The Incidental Detection Of Small Renal Masses (Srms) Which Is Less Than 4 Cm. (Jemal Et Al., 2009).This Rise Concurrently Been Met With A More Favorable Grade And Stage Migration (Chawla Et Al., 2006). This Shift In Clinicopathology Has Been Met With A Paradigm Shift In The Treatment Of The Disease (Vricella Et Al., 2010). The Standard Treatment Of Rcc Is Radical Nephrectomy (Rn). Although Providing Excellent Cancer Control, Rn Sacrifices Many Normal Nephrons (David Et Al., 2010). In Addition, Long Term Contralateral Renal Dysfunction Due To Hyperfiltration Injury Is Significantly High .Also, Metachronous Contralateral Renal Tumour Can Occur In A Significant Proportion (10%) Of Patients (Lau Et Al., 2000). Considerable Progress Has Been Recently Focused In Minimally Invasive Nephron Sparing Surgery (Minss) Which Encompasses Laparoscopic Partial Nephrectomy (Lpn) (Weis And Winfield, 2005), Thermal Ablative Procedures As Cryoablation, Radiofrequency Ablation (Rfa), High Intensity Focused Ultrasound (Hifu), Microwave Ablation And Non Thermal Ablation As Histotripsy (Duffey And Kyle, 2010> All Minss Options Strive To Achieve Essential Goal Of Rn; Excision Or Destruction Of Renal Tumor With A Rim Of Healthy Tissue With Durable Functional And Oncological Outcome (Belldegrun Et Al., 2006). Guidelines On The Proper selection Of Patient And Treatment Modalities Have Been Developed And Established Allowing Patient To Benefit from Better Oncologic Efficacy And Reduced Morbidity (Ghoneim, 2009). The Current Trend Of Minss Management Will Continue To Expand The Role Of Radiodiagnosis Not Only Preoperatively But Also To Recognize The Typical Post Ablation Imaging And Surveillance For Residual Or Recurrent Tumor (Wile Et Al., 2007). Renal Biopsy For Localized Renal Tumor Is Likely To Increase Rapidly In The Coming Time With The Expanding Scope And Utilization Of Minss, This Diagnosis Modality Will Find Increased Applicability In The Management Protocols In The Future (Gagan And Kevin, 2009). The Technique Of Laparoscopic Partial Nephrectomy Has Matured Significantly Over The Past Decade And Emerging As Oncologically Sound Procedure For Management Of Small Renal Tumor. Methods Of Tumor Excision And Parenchymal Reconstruction In A Hemostatically Controlled Field Have Been Evolved To Make This Procedure Safer (Weis And Winfield, 2005).The Aim Of Cryosurgery Is To Ablate The Same Predetermined Volume Of Tissue That Would Have Been Removed By The Conventional Surgical Excision.The Mechanism Underlying Tissue Cryodestruction Is Thought To Involve Immediate Cellular Damage And Delayed Microcirculatory Failure (Languna Et Al., 2005).Radiofrequency Ablation Provides Heat Based Tissue Destruction. High Frequency Electrical Current Creates Molecular Friction Denaturation Of Cellular Protein And Cell Membrane Disintegration (Gravais Et Al., 2005)High Intensity Focused Ultrasound Has The Potential To Be The Least Invasive Tumor Ablative Technique, Similar To Extracorporeal Shock Wave Lithotripsy. This Beam Is Focused On The Lesion At Focal Zone (Wang Et Al., 2003). Histotripsy Causes Mechanical Destruction Of The Target Tissue And Shows Promise In Treating Small Renal Cell Carcinoma (Duffey And Kyle, 2010) |