Partial Nephrectomy

Partial nephrectomy is surgery that aims to preserve as much kidney function as possible by only removing the diseased part of the kidney. This is most commonly done for small kidney cancers but can sometimes be an option for complicated kidney stone problems or congenital (anatomical variations present from birth) conditions.

Traditionally this has been done as an open procedure with an incision through the flank to access the kidney but with the refinement of robotic techniques and technology, a minimally invasive approach is increasingly an option.

The abdominal space is accessed via small ports, inflated with CO2 gas and robotic instruments are inserted to perform the operation. The advanced da Vinci Surgical system is used for the procedure allowing the robotic instruments to be directed under the command of the surgeon who sits at a console.

Robotic surgery is commonly known as "keyhole surgery”, however, although the incisions are small the view is not. Modern equipment produces a wide, bright, clear, three-dimensional and magnified view of the operation, often superior to the traditional open approach. In addition, the gas used to distend the abdomen during laparoscopy also reduces bleeding during surgery.

The kidney is mobilised and the blood supply is isolated. The kidney receives a large supply of blood flow which must be controlled during the operation to prevent significant bleeding. This can be done by placing temporary clamping devices “Bulldog clips” on the vessels which are removed again at the end of the procedure. The diseased area is then resected and sent for pathological inspection. The remaining kidney is repaired with sutures. A temporary drain is routinely placed to remove any fluid from the area after the surgery and a urinary catheter is inserted to measure urine production during and after the operation. The entire operation is performed without the surgeon’s hands entering the body.

After the operation

Minimally invasive procedures are less traumatic than open procedures however this does not mean that they are pain-free. Medication will be given to keep pain at a manageable level to allow you to mobilise. It is important to get out of bed early in the recovery period. The benefits of this include avoiding blood clots and chest infections as well as promoting the return of normal bowel function. The nursing staff are very helpful with this process. Blood tests will be done after surgery and medical staff will review your progress on a regular basis as well. The drain and catheter will be removed as your recovery progresses. The sutures are dissolvable and do not need to be removed. Most patients are able to leave the hospital within 2 days of the operation. Follow-up will be discussed before your discharge, typically being arranged around 6 weeks postoperatively.

Although the incisions are small, a significant operation has taken place internally and as such you should not undertake strenuous physical exercise, even if you feel like it, until at least 6 weeks (A return to full activities may take 12 weeks with an open approach). You may drive as soon as you think you could brake hard and swerve quickly to avoid an accident (typically 2 weeks).