Laparoscopic / Open Partial Nephrectomy
Product Summary: Open / Laparoscopic partial nephrectomy
Item Number: 36522, 105; 36525, 105
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.
Curative process for Renal Cell Carcinoma.
Staging should be negative ie. No spread of tumour.
- Staging with:
- CT abdomen and chest.
- 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.
The correct side for surgery should be checked:
- CT scan present.
- Your approval.
- Prior to anaesthesia being commenced.
- 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!
- 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!