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Definition:
Open partial
nephrectomy is defined as a removal of a portion of the kidney to
achieve total removal of the entire tumor.
Technique:
Open partial nephrectomy is performed through a single
6- to 7 Inch abdominal or flank incision. As the incision is large
enough to work through, the procedure is done without the use of
a laparoscopic cameras' or gas to expand the body spaces. Open partial
nephrectomy is the kidney sparing surgery with the longest tract
record and is often considered the gold standard for nephron sparing
surgery. All of the new surgeries that have been introduced into
clinical practice are compared to open partial nephrectomy for control
of kidney cancer and for recovery from the operation.
Candidates:
Open partial
nephrectomy is ideally suited for the patient with larger renal
tumors that invade deeply into the renal tissue. Having an open
partial nephrectomy is often called for when these larger and deeper
kidney cancers exist in patients whose total kidney function is
limited or if the cancer exists in a patient with only one kidney.
Open partial nephrectomy is also ideally suited for patients who
are generally healthy and can tolerate general anesthesia.
Advantages / Disadvantages:
The advantages of open partial nephrectomy include the
ability to put sterile ice on the kidney to cool the kidney to very
low temperatures during the operation. Cooling the kidney prevents
damage to the kidney during the surgery, and kidney cooling can
only be efficiently done with open partial nephrectomy. In addition,
open partial nephrectomy is associated with a low rate of urinary
leakage, positive surgical margins (leaving cancer on the remaining
kidney), and blood transfusion.
The disadvantages of open partial nephrectomy when
compared to minimally invasive techniques are generally the differences
in short-term morbidity such as length of hospital stay, the need
for pain medication to control pain after the procedure, and time
to return to full activity.
The Procedure:
Open partial nephrectomy is performed via a subcostal or
flank incision under general anesthesia. The operative time is usually
3 to 3 1/2 hours, and an ultrasound device is utilized during the
operation to allow the surgeon to identify the tumor and precisely
remove it while sparing as much of the normal kidney as possible.
During the operation the kidney is temporarily cooled with ice to
protect against potential damage caused by lack of blood flow within
the kidney.
Follow-up:
Following an open partial nephrectomy operation, the final
pathology report is reviewed with the patient approximately one
week after the surgery, and appropriated imaging studies are arranged
on an interval basis to monitor both kidneys.
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