Partial Nephrectomy
Removal of a portion of the kidney (partial nephrectomy) is often possible when a patient develops a tumor on their kidney. Traditionally this procedure has been performed through a large incision across the ribcage or upper abdomen, resulting in a potentially long recovery. However, the same procedure can be performed with equal effectiveness laparoscopically, thereby lessening both the recovery and surgical risk.
Scott D. Miller, MD has one of the largest private practice experiences with laparoscopic kidney surgery in the country. Having specialized in urologic laparoscopy since 1995, he was the first urologist in the state of Georgia to perform laparoscopic removal of the kidney for cancer in 1995. As a result, he has one of the largest series of long-term kidney cancer data following laparoscopic radical nephrectomy. Since that time he has applied these skills to even more complex laparoscopic kidney surgeries, including laparoscopic and robotic partial nephrectomy.
Description
Similar to other laparoscopic procedures, the surgeon makes a button-size incision for the insertion of a telescope. After expanding the body cavity with carbon dioxide gas, two or three additional small incisions are made to place narrow tubes used for interchangeable instruments. The surgeon can then visualize the kidney and the interchangeable instruments on a television monitor. The kidney’s blood vessels are then located and fully exposed.
Once the abnormal area of the kidney is completely identified, the blood vessels are temporarily clamped (usually for 20-30 minutes) to prevent bleeding while incising the kidney. A small pair of scissors is used to carefully remove the tumor along with a small amount of normal surrounding tissue to help ensure complete removal. The specimen is then placed in a protective plastic bag that closes with a purse-string (all while inside the body). The opening in the kidney is meticulously repaired using dissolvable cloth, suture, and blood vessel sealant. After the clamp is removed, any additional repair is performed as deemed necessary.
The tumor is removed and taken to the pathologist for immediate examination of the edges. During this examination time, the kidney can be continuously observed for any evidence of bleeding. When satisfied with these findings, the skin openings are closed with shower-resistant glue as a substitute for both stitches and bandages.
Treatment Options
When cancer is isolated to the kidney, it is often curable with some type of surgical procedure. This type of cancer does not respond well to non-surgical treatment such as chemotherapy or radiation therapy. Therefore, it is essential to detect and treat the disease effectively before it spreads outside of the kidney. Kidney cancer treatment options are influenced by tumor size, tumor location, kidney function, patient health, patient age, and previous surgery.
Most kidney cancers can be cured by removing the entire kidney (radical nephrectomy) or part of the kidney (partial nephrectomy). Cancer that occurs in the lining of the kidney requires removal of the kidney and the entire drainage tube (nephrouterectomy). Removal of the entire kidney may not be appropriate for patients with one kidney, poor kidney function, or other diseases that might affect kidney function in the future (such as diabetes or high blood pressure). These patients may be better served with removal of part of the kidney (partial nephrectomy) or destruction of the actual lesion (cryoablation of renal mass). Some elderly patients with small tumors do not require any treatment other than careful observation. All of these procedures can be performed with laparoscopic (telescopic) kidney surgery through small “button-hole” incisions.
Results & More
Laparoscopic partial nephrectomy facilitates quicker recovery, less pain, and a lower complication rate as compared to the typical open-incision partial kidney removal. Obviously, the primary goal is cancer cure. Our cure rates have either matched or surpassed any other published series for open-incision partial kidney removal. Vast experience and a world-class surgical team help ensure this high level of success.
Most patients are discharged from the hospital the day following surgery. Risk of damage to surrounding organs, blood clots, pneumonia, and wound infection are each under 1%. The chance of needing a blood transfusion is between 4% and 8%, depending on the amount of kidney removed. As compared to complete kidney removal, the higher risk of transfusion is balanced by the benefit of preserving the kidney. A drainage tube is often left in place for 1-2 days in case there is temporary leakage of urine from the kidney. Long-term leakage is a rare event in our experience.
FAQs
Q: How do I keep my kidney(s) healthy?
A: The kidneys are very vascular organs. For that reason, whatever is healthy for the body tends to be healthy for the kidney. The obvious recommendations are exercise, a balanced diet, and management of other medical conditions such as high cholesterol, hypertension, and diabetes. Of course, smoking is detrimental to both kidney and overall health. Although protein restriction is usually unnecessary, seek the advice of a physician prior to starting a high protein diet. A physician can also advise you of any medications to minimize or avoid.
Q: What are the risks of partial kidney removal compared to complete removal?
A: The risks of urine leak and bleeding are higher with partial removal. However, this difference in risk may be justified in order to preserve the rest of the kidney.
Q: How much pain can I expect after the procedure?
A: Pain is typically less with laparoscopic procedures when compared to open-incision surgery. Some abdominal cramps and shoulder discomfort can occur from the carbon dioxide gas used during surgery. This type of pain is best treated with anti-inflammatories rather than narcotics. Although everyone is different, post-operative discomfort is usually easily managed and short-lived.
Q: Is bruising normal after a laparoscopic procedure?
A: When a narrow tube is placed through a button-size skin incision, a small blood vessel just below the skin can break. However, since the snug fit of this tube will compress the blood vessel during surgery, bleeding will often not occur. If this blood vessel were to re-open at a later time, a small amount of blood could track over a large surrounding area (including the genitalia). This is not a true bruise but will have the same appearance. Most important, this finding is not an indication of internal problems.
Q: When can I return to work or other normal activities following my surgical procedure?
A: Dr. Scott Miller recommends at least two weeks away from work. Very few jobs would require more than four weeks of leave. In many cases, a small amount of light work-related duties are acceptable during the first two weeks. All patients should move around frequently from the time of surgery and resume light exercise at one week (gradually increasing to a normal routine by four weeks). Driving a car is often reasonable in approximately one week if reaction time is good. Of course, Dr. Scott Miller will provide guidance for each individual situation.
Q: Are lymph nodes removed during a laparoscopic partial nephrectomy?
A: Unless an abnormal lymph node is encountered, lymph node removal is typically not needed.
Q: How long does the surgery take Dr. Scott Miller to perform?
A: Although many variables can affect the time necessary for Dr. Scott Miller to meticulously perform the surgery, he usually completes the procedure in 2-3 hours. However, the time away from family members also includes preparation (30-40 minutes), anesthetic reversal (15-20 minutes), and recovery room stay (2 or more hours). Dr. Scott Miller asks patients to arrive two hours prior to this process, during which time family members can remain present. Occasional updates are given to the family by the operating room nurse. Dr. Scott Miller will come to the waiting area when the patient is ready for transfer to the recovery room.
Q: How long do I stay in the hospital following surgery?
A: Most patients are ready for discharge on the day following surgery.
Q: How does cancer cure with laparoscopic partial nephrectomy compare to open-incision partial kidney removal?
A: Dr. Scott Miller’s oncologic (cancer-related) outcomes match nationally published data for open-incision surgery from the premier academic centers. Since Dr. Scott Miller performs a much higher volume of kidney surgeries than the average urologist, he is able to achieve these results.
Q: Should I donate blood prior to my procedure?
A: Since the risk of needing a blood transfusion is between 2% and 8%, blood donation is optional.
Q: When can I shower or bathe following my surgery?
A: Since shower-resistant glue was used as a substitute for both stitches and bandages, showering is acceptable once discharged from the hospital. Although water will not harm the surgical areas, mechanical cleansing of the incisions should be avoided for the first week to prevent premature removal of the glue. Complete immersion such as bathing or swimming is allowed at two weeks.
Q: What long-term follow-up care will I need?
A: Following examination of the tumor by the pathologist, Dr. Scott Miller will recommend a schedule for any follow-up x-rays and blood tests.
Q: What other cancer treatments will I need after my surgery?
A: No other treatments (such as radiation or chemotherapy) are routinely recommended unless disease is discovered outside of the kidney.
Q: Does tumor size influence whether I am a candidate for laparoscopic partial nephrectomy?
A: Both tumor size and location influence whether a patient is a candidate for partial removal. Dr. Scott Miller will make his recommendation based on his review of the CT scan or MRI films.
More Information
When cancer is isolated to the kidney, it is often curable with some type of surgical procedure. This type of cancer does not respond well to non-surgical treatment such as chemotherapy or radiation therapy. Therefore, it is essential to detect and treat the disease effectively before it spreads outside of the kidney. Kidney cancer treatment options are influenced by tumor size, tumor location, kidney function, patient health, patient age, and previous surgery.
