Partial nephrectomy, or renal resection, involves surgical removal of part of the kidney to excise diseased tissue, while preserving as much kidney mass and function as possible. In contrast to complete removal of the kidney, a partial nephrectomy is performed, when a patient has only one kidney. Partial nephrectomies are possible with diseases such as lesions, tuberculosis, small (3-5 cm) cancerous tumors, or injuries, or physical damage to the kidney.
Partial nephrectomy is a preserving type of surgery. Even though the kidneys are paired organs, a problem with one kidney increases the load on the other kidney significantly. Therefore, the possibility to preserve even a small part of the failing kidney can reduce some of the load on the healthy kidney, and provide significant support for bodily functions, thus, helping the patient to achieve a higher quality of life. Partial nephrectomy offers effective protection against cancer relapse for patients, who have small, localized solid masses and no other potential complications such as scarring or renal disease.
Surgery for a partial nephrectomy is conducted in one of two ways: conventional (where incisions open the body cavity), or laparoscopy (removal of the damaged tissue through small incisions on the front surface of the abdomen). No matter which method of operation is used, the procedure is performed under general anesthesia, and there are standard preoperative preparations the patient must undergo, such as blood and urine tests and consultation with an anesthesiologist.
The surgical procedure for either method includes the following steps:
- The body is prepared for surgery and the patient is anesthetized.
- In order to prevent excessive bleeding, a special device is applied into the renal stem.
- The resection of the affected area is performed, the diseased tissue is removed, and the remaining parts are stitched together.
- A drainage tube is installed, and the patient goes to the recovery room for monitoring.
Traditional Open Resection Surgery
After the procedure, the patient has to take painkillers and antibiotics for 10-14 days. The drain is removed within a few days.
The traditional or open resection surgery method allows the surgeon a greater access to the kidney, and there is less tissue injury than with a total nephrectomy. As a result, the possibility of complications and side effects after this operation is lower. Nevertheless, special attention is needed to avoid complications. For example, patients are encouraged to move and be as active as they can in order to avoid problems such as pneumonia, thrombosis that can develop in the postoperative period if the patient lies still at all times. The nurse will suggest breathing exercises, and provide opportunities to walk and move. It is also important to move in order to improve bowel function, which can be rather sluggish after general anesthesia and abdominal surgery.
Partial nephrectomy using the laparoscopic approach can be performed either through the abdomen (transabdominal method) or outside of the abdominal cavity (retroperitoneal method). The laparoscopic approach is less invasive, and is considered the most effective in cases when the patient has a small tumor, growing on the outside of the kidney.
For laparoscopic surgery the surgeon requires vast experience and knowledge. Before such an operation, he or she creates a pneumoperitoneum, in which the abdominal cavity is filled with special gas that is fed through the needle. After that, small incisions are made, through which the microscopic surgical tools are inserted. Once they are inside, the surgery follows the same general procedures outlined above. In order to prevent bleeding after surgery, the surgeon often uses a special haemostatic film placed in a remote section of the surgical zone.
The laparoscopic approach is considered gentler and is associated with fewer complications such as inflammation, bowel dysfunction, and blood clots (a serious risk factor for stroke or heart attack). The patient also begins to lead an active lifestyle much faster, so side effects and complications after laparoscopic operations are rare.