Partial Nephrectomy

Partial Nephrectomy, also referred to as "nephron-sparing surgery" or "kidney-sparing surgery" is a surgical procedure performed on the kidneys.
It is usually performed to remove a tumor from one or both kidneys. These tumors can be both cancerous and noncancerous (benign). A Nephrectomy may also be also necessary due to other kidney diseases.
During Partial Nephrectomy, the surgeon only removes the tumor and saves the rest of the kidney. This is a delicate procedure that requires an experienced surgeon and surgical team. A Partial Nephrectomy can be performed via open or robotic-assisted laparoscopic surgery.

The major advantage is preserving kidney function
Patients who have poor kidney function are more likely to suffer from heart disease and have shorter life expectancy
Partial Nephrectomy and its potential benefits may not apply to everyone and thus your personal case should be discussed

Dissection of the kidney and the vessels (renal artery and vein) feeding the kidney and the tumor
An intra-operative ultrasound is used to verify tumor location and configuration
The renal vessels (arteries) are clamped
The tumor is removed and then the tumor bed is closed with suture
The vessels are unclamped
The remaining kidney, repair and vessels are inspected to ensure there is no bleeding

In general, the robotic approach yields smaller incisions, less postoperative pain and a shorter hospital stay
Robotic-Assisted Partial Nephrectomy is associated with a shorter operation, less bleeding and a shorter ischemia time than the standard laparoscopic approach

Frequently Asked Questions

First and foremost, the tumor must be in a location that would make a Partial Nephrectomy feasible and safe
Experienced surgeons specializing in Partial Nephrectomy have the best chance at removing difficult tumors successfully

A patient who already suffers from kidney failure. If this patient loses a kidney, he/she are more likely to require dialysis—which will result in a worsened quality (and potentially quantity) of life.
A patient who has tumors in both kidneys. Saving one or both kidneys will help this patient avoid kidney failure as well.
A patient who has risk factors for kidney failure. The most common reasons patients have poor kidney function today are diabetes and high blood pressure. Having these conditions means you may already have worse kidney function than you think. Saving the kidney will maintain a better kidney function and prevent kidney failure in the future.
A patient who has kidney stones. If you have one kidney and a stone decides to pass and block the ureter, it becomes a medical emergency. The blockage not only harms your remaining kidney but blocks any urine from going through to your bladder.
Any patient in which the tumor can be safely removed via Partial Nephrectomy. Since we do not know what the future may bring, saving the kidney is usually preferable. Again, for certain patients this may not be desirable and a discussion with an expert Urologist is necessary.

Surgeons who routinely perform partial nephrectomy are rare.
Studies estimate that Partial Nephrectomy is underutilized due to the skills set and experience required to be comfortable with this advanced procedure.
Surgeons have traditionally removed the entire kidney as this is an easier procedure to master.
Experienced Partial Nephrectomy experts rarely have to remove the entire kidney in this setting.
For small kidney tumors (less than 4 cm), our experts perform a Partial Nephrectomy more than 90 percent of the time when surgery is undertaken. It remains that for the rare tumor, it might be technically impossible to save the kidney.
Two surgeons may disagree on what constitutes a tumor that can be removed via Partial Nephrectomy. We advise that you consult with an expert before making a decision.

Since the kidney is left in place, the raw surface where the tumor was cut can bleed. A delayed bleed occurs rarely (one percent to two percent of the time). Signs and symptoms of this are severe flank or abdominal pain, bruising on the side, or blood in the urine. Treatment for this is usually conservative (bedrest or a radiology procedure called embolization.
It is best that you ensure that your care team/hospital are experienced with this rare procedure.
Another rare but unique complication of Partial Nephrectomy is a urine leak. Urine can find its way out of the hole that is made by cutting the tumor out. Despite all efforts to seal the kidney at the time of surgery, about one percent of the time a urine leak will occur. If this occurs, it usually seals on its own. Sometimes a ureteral stent (a straw-like structure placed in the ureter) is required to create a path of least resistance down the ureter rather than through the cut surface of the kidney.
These two complications do not occur when the entire kidney is removed.

Ischemia time refers to the amount of time that the surgeon temporarily blocks the blood vessels going into the kidney. The vessels are blocked to allow cutting the tumor in a bloodless field which allows the surgeon to see well and keeps the operation safe. Occasionally the surgeon can cut the tumor without blocking the vessels (no ischemia).
A shorter ischemia time is desirable but it is important not to obsess over this point as studies have questioned the significance of ischemia time in harming the kidney. It is generally agreed upon, however, that an ischemia time less than 45 minutes is probably safe—although a shorter period is highly desirable especially in patients with compromised kidney function.
Although ischemia time is important, renal preservation or the amount of normal kidney left, is more important to preserve renal function.