Laparoscopic / Open Partial Nephrectomy

For small renal cancers where nephron-sparing is an issue. Similar to an open Radical Nephrectomy.

Why is it done?

Incidental finding of a solid renal mass larger than 3cm suspicious of a renal cancer.

Exophytic lesion.

Usually asymptomatic.

Curative process for Renal Cell Carcinoma.

Staging should be negative ie. No spread of tumour.

• Staging with:
• CT abdomen and chest.
• Bonescan.
• MRI if in Renal Failure or Contrast Allergy.

How is it done?

• • Patients will receive a general anaesthesia, unless contra-indicated.
  • Prophylactic anti-biotics is given.
  • An indwelling catheter is placed.
  • The correct kidney is identified and marked while you are a.
  • Depending on the side of the tumour 3-4 incisions will be made: 1 for the hand-port of approximately 8cm depending on the amount of sub-cutaneous fat present 1 for the camera-port 1 for the working-port (1 for the liver retractor on the right).
  • The colon is reflected to reveal the retro-peritoneal space.
  • The ureter is identified and cleared up to the hilum.
  • The arteries are identified and marked with vessel loops More than 1 can be present. Confirmed with CT arteriography.
  • Then the vein/ viens are identified and marked with a vessel loop.

• The tumour is identified using intraoperative ultrasound and marking the area with a 0.5cm margin with cautery. Its overlying fat removed is removed and sent for histology.
• Note is made of the depth of the tumour.
• Vessel clamps are placed on the artery and the tumour is cut out with a combination of blunt and sharp dissection. Bleedres are clipped as encountered.
• Collecting system is closed if exposed.
• Vessel occlusion is released with a check for bleeding vessles in the wound.
• Compressing parenchymal sutures are place over a hemosostatic agent role.
• A drain is left post-operatively.

Very Important!

The correct side for surgery should be checked:

• CT scan present.
• Your approval.
• Prior to anaesthesia being commenced.

What next?

• You will spend up to 3-5 nights in hospital.
• You will have a catheter for that time.
• A drain for 2-3 days.
• Your darin will be removed with minimal drainage present.
• You will a trial without the catheter on the 3rd day.
• You will be discharged as soon as your renal function has stabilised and you have opened your bowels.
• Allow for 6 weeks for stabilization of symptoms.
• No dietary restrictions apply.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
• Don’t hesitate to ask Jo if you have any queries.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Risks

• Blood loss 20-500cc.
• May convert from a laparoscopic to open procedure.
• May loose your kidney in up to 5% of cases.
• Wound Infection.
• Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
• NB! Each person is unique and for this reason symptoms vary!

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Laparoscopic / Open Partial Nephrectomy