Laparoscopic partial nephrectomy
This procedure entails surgically removing a part of the kidney. Depending on the condition of the kidney, previous abdominal surgeries, and other factors, we take either the transperitoneal or the extraperitoneal approach. The laparoscopic partial nephrectomy is widely considered to be the riskiest, most dangerous laparoscopic surgery in the field or urology, when used to treat kidney tumors. Not only is there a relatively high chance of bleeding during the surgery, but it’s also necessary to seriously limit how long we can block the blood supply (20-30 minutes at most), which requires a highly skilled laparoscopic team. As such, laparoscopic partial nephrectomy is performed only in medical centers with extensive experience in kidney surgery and laparoscopy.
When is it needed?
Laparoscopic partial nephrectomy is used in patients with minor kidney tumors and certain other non-malignant conditions. In some cases, for example when the tumor has a limited capsule smaller than 3 cm, there is also the option of tumor enucleation.
How is it performed?
In order to perform laparoscopic partial nephrectomy, we require 3-4 trocars inserted through the left or the right side of the abdomen. When done extraperitoneally with balloon dilation, an artificial space is made in front of the peritoneum, and trocars are inserted there. When done transperitoneally, the trocars are inserted into the abdomen itself. After detaching the colon and opening the parietal peritoneum above the affected kidney, the kidney is mobilized and the appropriate blood vessels are identified. If operating on a tumor, we need to approach it with care and precision, making sure to preserve the fatty capsule above the tumor itself. After temporarily blocking the blood supply through the renal artery (in rare cases clamping only the branch of the main artery), we remove the part of the kidney with the tumor. After that we stitch the renal collecting system closed (if it had been open), and take utmost care to prevent bleeding that might happen after releasing the blood supply back into the kidney. The removed part of the kidney is inserted in an endoscopic bag. We wrap up the procedure by inserting a drainage tube in order to monitor and control possible post-operative bleeding. The endoscopic bag is removed through an extended incision made in the best spot of the muscle wall to avoid cutting muscle. The remaining trocars are removed, and the incisions are stitched up.
What are the possible complications?
In the hands of an experienced surgical team, complications in laparoscopic partial nephrectomies are relatively rare. The most common possible complication is bleeding, which require a blood transfusion in about 10% of the cases. There are also general risks of laparoscopic surgery, such as the damage of stomach organs. However, these risks are minimal and occur in less than 1% of all patients. Approximately 5% of laparoscopic partial nephrectomy surgeries require a conversion to the open surgical approach. Additionally, in 5% of the cases, there may be a need to switch to radical nephrectomy intra-operatively.
