Partial Nephrectomy (Open, Laparoscopic, and Robotic)

A partial nephrectomy is performed to remove small tumors from the kidney. The goal is to remove the entire tumor while preserving as much normal kidney tissue as possible. There are many factors that determine whether or not your urologist will choose partial nephrectomy instead of total nephrectomy (removal of the entire kidney), including the size of the tumor, its location, and patient-specific factors such as body mass index, need for blood-thinners, and general medical condition. The procedure is performed in the operating room under general anesthesia and typically takes 3-5 hours.

For a traditional partial nephrectomy a 10-12cm incision is made in the flank area. The skin is incised and then multiple muscle and fascial layers are divided in order to gain access to the kidney. In some cases a portion of the rib will be removed to gain better exposure. The ureter and renal vessels are exposed and the kidney is freed from surrounding tissue to identify the tumor. The renal vessels are then temporarily clamped while the tumor is excised with a rim of healthy tissue surrounding it. Sometimes the kidney is cooled with ice to preserve its function. Special packing material is placed into the tumor cavity to prevent bleeding and the kidney is reconstructed using sutures.

Typically, the open approach is performed for larger tumors, kidneys that have scar tissue surrounding them, and for complex cases. For laparoscopic or robotic nephrectomy, also called minimally invasive partial nephrectomy, a number of small 2 cm incisions are made in the abdomen. The robotic arms are used to control instruments that expose the renal vessels and the tumor. The renal vessels are may be temporarily clamped to stop blood flow to the kidney and the tumor is excised with a rim of healthy tissue surrounding it. Special packing material is placed within the excised tumor cavity to prevent bleeding and the kidney is reconstructed using sutures. The tumor is then removed through one of the small incisions. The skin and fascial layers are closed with dissolvable sutures or “skin glue”. Hospital times and pain are significantly less with this approach.

What to expect afterwards:

You will be in the hospital for usually 1-2 days following surgery. A surgical drain and foley catheter are placed at the time of both surgeries. Typically they are removed prior to discharge from the hospital. Pathology results will be discussed at your follow-up visit.

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