Partial nephrectomy, also known as nephron-sparing surgery, primarily focuses on removing a kidney tumour while preserving as much surrounding healthy kidney tissue as possible.
This procedure is especially beneficial for maintaining overall kidney function and is preferred over radical nephrectomy, which involves removing the entire kidney. By preserving kidney tissue, partial nephrectomy minimises the risk of chronic kidney disease after surgery. Read on to learn more about partial nephrectomy, including the surgical techniques and postoperative care involved.
When is Partial Nephrectomy Recommended?
Partial nephrectomy is recommended for people with localised kidney tumours when preserving renal function is a priority. It is most commonly recommended in the following scenarios:
- Small Renal Masses: Typically, tumours that are 4 cm or smaller (T1a) are ideal candidates for partial nephrectomy. These small masses are often detected incidentally during imaging for other conditions.
- Solitary Kidney: For patients with only one functioning kidney, partial nephrectomy is important for preserving as much renal function as possible, thus avoiding the need for dialysis.
- Bilateral Renal Tumours: When tumours are present in both kidneys, partial nephrectomy can be performed to treat tumours on both sides, thus maintaining some degree of kidney function.
- Pre-existing Renal Conditions: In individuals with pre-existing conditions such as chronic kidney disease, where overall renal function is already compromised, nephron-sparing surgery helps to preserve the remaining renal function.
- Genetic Predisposition: Patients with hereditary syndromes that predispose them to multiple kidney tumours, such as von Hippel-Lindau disease, are also candidates for multiple partial nephrectomies over their lifetime.
Preoperative Preparation and Assessment
The preoperative preparation and assessment phase includes a comprehensive evaluation of the patient’s overall health and kidney function.
- Health Assessment: A thorough medical evaluation is conducted to assess the patient’s general health and identify any coexisting medical conditions that may affect surgery or anaesthesia.
- Renal Function Tests: Kidney function is assessed through blood tests, including serum creatinine and blood urea nitrogen (BUN) levels, to ensure the remaining kidney can function adequately post-surgery.
- Imaging Studies: Techniques such as computed tomography (CT) scans, magnetic resonance imaging (MRI), or ultrasound are used to determine the tumour’s size, location, and relationship to surrounding structures in the kidney.
- Renal Artery Imaging: Specialised imaging techniques, such as CT angiography or MR angiography, provide a detailed view of the renal vasculature. This is important for surgical planning to minimise blood loss and ensure precise tumour removal.
Surgical Techniques
The surgical techniques for partial nephrectomy can vary based on the tumour’s characteristics and the patient’s overall health. Here are the primary approaches used:
Open Partial Nephrectomy
This traditional method involves a larger incision to access the kidney directly. It is often used for complex tumours or when the surgeon requires more direct visualisation and access.
Laparoscopic Partial Nephrectomy
This minimally invasive approach uses small incisions and a camera to guide the surgery. This method typically results in less pain and a quicker recovery compared to open surgery.
Robot-Assisted Laparoscopic Partial Nephrectomy
This is an advanced form of laparoscopic surgery where the surgeon uses a robotic system to enhance precision, flexibility, and control during the operation. This technique is beneficial for intricate surgeries.
Key Surgical Considerations
- Ischaemia Time: This refers to when blood flow to the kidney is reduced or halted to facilitate tumour removal. Minimising ischaemia time is crucial to protect kidney function.
- Tumour Location: The approach may vary significantly depending on whether the tumour is located near the surface or deep within the kidney.
- Tumour Size and Complexity: Larger or more complex tumours might require more extensive reconstruction of the kidney post-tumour removal.
Postoperative Care and Management
Effective postoperative care is essential for a successful recovery after a partial nephrectomy.
- Monitoring: Regular assessment of kidney function through blood tests and urine output is critical to ensure the remaining kidney compensates adequately.
- Pain Management: Pain is managed through medications, which may include oral or intravenous options, depending on the intensity of the pain and the patient’s overall health.
- Infection Prevention: Prophylactic antibiotics may be administered to prevent infections, and wound care is meticulously managed to ensure clean, dry, and intact dressings.
- Physical Activity: A gradual increase in physical activity is encouraged to promote circulation and prevent blood clots. Patients are typically advised to avoid strenuous activities or heavy lifting for several weeks.
- Dietary Management: Adequate hydration and a balanced diet rich in essential nutrients support healing and kidney health.
Conclusion
Partial nephrectomy is a crucial surgical option for individuals diagnosed with kidney tumours, designed to remove the malignancy while preserving as much kidney functionality as possible. This approach aims to benefit patients by supporting better long-term kidney health and overall well-being.
If you’re considering partial nephrectomy or seeking more information about your options, get in touch with us. Our clinic provides expert consultations and treatment plans tailored to meet personalised patient needs.
