Procedure– Nephrectomy means removal of one kidney and partial nephrectomy means partial removal of one kidney. This operation is done for tumor in one portion of kidney.

During partial nephrectomy, the urologic surgeon tries to removal a part of the kidney but many a times he has to convert the procedure to radical nephrectomy (complete removal of one kidney) if the tumor is found to be big or difficult to save the kidney due to bleeding. After radical nephrectomy patient is left with one kidney only.

Partial Nephrectomy operation can be done by Laparoscopic or open approach.

Laparoscopic/Robotic Partial Nephrectomy– In this operation 4-5 small holes of 5-10 mm size are made on the abdomen and kidney operation is performed. After the kidney tumor is dissected from the kidney, its removed by a small incision of approximately 4-5 cm size in the abdomen. Post operative pain is lesser than an open approach and recovery is faster. However, many a times operation is converted to open due to some intraoperative difficulty like adhesions, bleeding, abnormal anatomy, decreased oxygen saturation etc. The decision to convert to open surgery is taken during the operation depending upon the situation hence patient has to be ready for both open and laparoscopic approach.

Open partial Nephrectomy- In open surgery the incision is given on the flank and is about 15 -20 cm long. Here the 12 rib is excised for proper exposure of the kidney. The stitches are placed in several layers to close the incision site. The stitches on the skin are cut after 2 weeks

Hospital stay- Total hospital stay in such cases varies from 4-6 days depending upon the recovery of the patient . Patient may be kept in the ICU for one day to monitor the parameters.

After the procedure

Recovery time after the procedure and the length of your hospital stay depend on your overall health and the type of partial nephrectomy performed. The urinary catheter remains in place for a short time during your recovery.

Expect to receive instructions before leaving the hospital about restrictions to your diet and activities. You may be encouraged to begin light, everyday activities as soon as you feel able, but you’ll need to avoid strenuous activity or heavy lifting for several weeks.

For most patients, these procedures don’t affect quality of life — once you’re completely recovered, you can expect to resume your normal routine and activities.

Risks and complications –

1. Bleeding requiring blood transfusion- Nephrectomy is a major surgery so blood is always arranged and kept in blood bank for any intraoperative or postoperative blood transfusion need. Such transfusions are needed in 13% of patients.
2. Infection_-post operative wound infection may happen in 10% of cases which may require prolonged antibiotics and dressing.
3. Visceral complications- Injury to the surrounding organs of kidney like Liver, Spleen, Lungs, duodenum, Pancreas, colon or diaphragm may happen which require immediate measures to repair it. Such incidence are rare and happens in lesser than 15% of patients.
4. Pneumonia- In 13 % of patients respiratory problems like atelectasis or pneumonia may arise due to anesthesia effect . Post operative pain may sometimes pose difficulty in breathing especially in open surgery in obese or old patients.
5. Anesthesia related complications like chest infection, vomiting, headache may occur for few days in some patients.
6. Reoperation is carried out in 3.0% of the cases for some post operative complications. Overall mortality rate (<30 days) is 3.1%.
7. Deep venous thrombosis (DVT) and thromboembolism- This means formation of blood clots in large veins of limb which may migrate to distant veins/ lungs and heart. This is a rare phenomenon and reported in <1% of patients .

Long-term complications from partial nephrectomy relate to potential problems of living with less than two complete, fully functioning kidneys. Although overall kidney function decreases after a partial nephrectomy, the remaining kidney tissue usually works well enough for a healthy life.