Partial Nephrectomy

Overview

A partial nephrectomy is a surgical procedure where a surgeon removes a portion of your kidney to address a disease or injury. After correcting the underlying condition, the surgeon reconstructs the kidney.

The primary objective of a partial nephrectomy is to eliminate the diseased or damaged segment of the kidney while preserving as much healthy tissue as possible. Preserving kidney function is crucial since the kidneys act as the main filters in your body and are essential for life. Maintaining two functioning kidneys contributes to overall kidney function.

In a conventional open partial nephrectomy, your doctor makes one or more large incisions in your abdomen. This approach is typically recommended for large or invasive kidney tumors. Alternatively, the procedure can be performed laparoscopically, which involves two to four small incisions of half an inch or less in the abdomen. A thin rod with a camera (laparoscope) is inserted into one incision for internal visualization, while surgical tools are introduced through the other incisions.

For individuals with a small kidney tumor or those at risk of kidney failure necessitating dialysis if the entire kidney is removed, a robotic partial nephrectomy may be recommended. This approach involves robotic-assisted surgery, allowing the surgeon to control the robot’s arms with precision in challenging areas within the body. This method is significantly less invasive than an open partial nephrectomy.

Reasons for undergoing the procedure

Several conditions may necessitate a partial nephrectomy for treatment, including:

• Infection.
• Injury.
• Birth defects.
• Kidney cancer.
• Damage caused by kidney stones.
• High blood pressure resulting from blood supply issues to the kidneys.

Risks

Every surgical procedure carries inherent risks, and some of the risks associated with a partial nephrectomy include:

• Infection.
• Anesthesia-related risks.
• Potential requirement for a blood transfusion.
• Complications in the healing process.
• Formation of a mass of clotted blood (hematoma).
• Accumulation of fluid at surgical sites (seroma).
• Formation of blood clots.

Before the procedure

Before undergoing a partial nephrectomy, you will have a consultation with a doctor who will determine the most suitable procedure for you, which may include an open or robotic partial nephrectomy.

Your overall health will be assessed, and vital signs such as temperature, pulse, and blood pressure will be checked. It is crucial to inform your doctor about all medications, both prescription and Over-The-Counter (OTC), including herbal supplements. Certain medications, such as aspirin, blood thinners, anti-inflammatory drugs, and specific herbal supplements, can elevate the risk of bleeding. Consult your doctor before discontinuing any medications.

Allergies, including those to medications, skin cleansers (like iodine or isopropyl alcohol), latex, and foods, should be disclosed to the doctor.

Specific instructions on fasting before the partial nephrectomy will be provided by your doctor. Typically, you should refrain from eating or drinking anything after midnight the night before the surgery. If necessary, you can take prescribed medications with a small sip of water.

For kidney tumors smaller than 1.5 inches (4 centimeters), a robotic partial nephrectomy may be recommended. However, if the tumor size ranges from 1.5 inches to 2.8 inches (4 cm to 7 cm), the doctor may still consider treatment options based on the tumor’s location in the kidney.

During the procedure

A specialized team of healthcare providers, typically consisting of a urologist, an anesthesiologist, and nurses, will conduct a partial nephrectomy.

The anesthesiologist will administer general anesthesia, ensuring that you are sedated and unconscious throughout the procedure. While under anesthesia, a urinary catheter will be inserted to drain urine from your bladder into a bag.

The specific procedure details vary depending on whether it is an open partial nephrectomy or a robotic partial nephrectomy.

Open Partial Nephrectomy: In an open partial nephrectomy, the urologist will use a sterile scalpel to make a careful incision in your flank, the fleshy part on the side of your torso between your hip and ribs. The incision can be as long as 12 inches (30 centimeters), providing a clear view of the kidney. The urologist will use hands-on techniques to address the condition and reconstruct the kidney. Temporary blocking of blood vessels with a clamp and application of ice to the kidney are part of the procedure to slow tissue breakdown due to reduced blood flow.

Robotic Partial Nephrectomy: During a robotic partial nephrectomy, the urologist will make small incisions in your abdomen using a scalpel, each no larger than about 3/4 of an inch (2 centimeters). A laparoscope (thin rod with a camera) and robotic surgical equipment will be inserted through these small incisions. Carbon dioxide gas is introduced into the abdominal cavity to create space for the urologist to maneuver the surgical equipment and access the kidney. The robot is utilized to halt blood flow to the kidney, address the condition, and reconstruct the kidney.

Upon completing the kidney reconstruction, the urologist will close the incisions using stitches and/or staples. Small silicone tubes (drainage tubes) may be stitched in the incision sites to remove blood or fluid from the body, typically remaining in place for a few days.

Performing a partial nephrectomy typically requires a duration of three to four hours.

After the procedure

Following a partial nephrectomy, your doctor will secure your stitches with bandages. In the case of a tumor, it will be sent to a laboratory for examination by researchers.

The administration of anesthesia will cease, and within a few minutes, you will regain consciousness, although you may still feel groggy. Subsequently, you will be transferred to a recovery room, where the doctor will monitor your awakening and overall health.

Pain management will be initiated once you are fully awake. While a robotic partial nephrectomy is generally less painful than an open procedure, you will still require pain medication and management techniques.

Nausea is a common side effect of anesthesia, and if experienced, the doctor will administer medication to alleviate it.

A liquid diet is recommended for the initial one to two days post-surgery to aid in recovery. As your healing progresses, the doctor will gradually reintroduce solid foods.

On the day after surgery, providers will encourage you to engage in light activities, such as walking, to stimulate healing, enhance blood flow, and restore function to the affected areas. This also serves to prevent complications like blood clots in the legs and pneumonia.

Around the second day post-surgery, the urinary catheter will be removed by a doctor.

Once it is determined that you are in good health and no longer require monitoring, you will be discharged to go home. A family member or friend should be available to drive you home, and it is advisable to have assistance with daily activities for at least a few days, as lifting heavy objects will be restricted during the initial recovery period. After undergoing a robotic partial nephrectomy, patients typically stay in the hospital for one to two days, whereas for an open partial nephrectomy, the typical hospital stay extends to three to four days.

Outcome

The duration of your recovery is influenced by factors such as the type of partial nephrectomy, your health history, and any additional conditions you may have. For precise details about your recovery timeline, consulting with your doctor is essential.

Typically, individuals undergoing an open partial nephrectomy can expect to return to normal activities within eight to 12 weeks. Recovery tends to be faster for those undergoing a robotic partial nephrectomy, with most individuals resuming normal activities within four to six weeks.