Tumor removal with kidney preservation. Partial Nephrectomy

In the case of a benign or malignant tumor of the kidney (as a rule, kidney carcinoma, papillary renal adenoma, oncocytoma, angiomyolipoma, metanephritic adenoma, metanephric adenofibroma, mixed epithelial and stromal tumors (MEST), Bosniac), the most effective treatment in Israel is surgical removal by laparoscopic method (laparoscopy).

The operation of partial removal of the kidney or tumor allows to maintain a healthy part of the kidney without exposing the patient to the risk of cancer recurrence. This operation is also known as “kidney surgery”, Partial Nephrectomy or Nephron-Sparing Surgery.

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Unlike radical nephrectomy (complete removal of the kidney), which leaves the patient with only one kidney, in a partial removal operation the patient remains, in essence, with the “kidney and a half kidney”. In this case, half of the kidney can retain most of its original functions.

Typically, with tumors up to 4 cm, partial removal with preservation of the kidney is possible, but all cases are individual, and our surgeon needs to review the images in order to determine the appropriate method and volume of the operation.

In situations where the tumor is large or its location does not allow partial partial resection, radical (complete) removal of the kidney is performed.

Simple nephrectomy can also be performed not because of cancer, but when the kidney is dysfunctional (does not fulfill its function). But not every dysfunctional kidney requires immediate surgical intervention, and many people live with such a kidney for a long time. Resection of the kidneys is an opportunity that is used when a nonfunctional kidney is harmful to health, and the best way is to remove it, then leave it in the body. Conditions that lead to damage and dysfunction of the kidneys include:

– dysfunction of the kidney, which produces stones that cause periodic pain in the patient.

– hypertension (narrowing of the coronary artery);

– infected abscesses or kidney cysts that cause recurrent urinary tract infections;

– some not cancerous tumors that require such surgery.

Except in cases of voluntary donation, kidney resection is performed because of kidney disease or local injury, which requires removal of the diseased organ.

It is important to note that our body can continue to function normally for many years with a single kidney because the kidney undergoes biological changes that allow it to function as two kidneys and compensate for kidney failure.

What are the expected results?
The purpose of removing the kidney is to completely rid the patient of a disease that can spread to the entire body.

How is the operation performed to partially or completely remove the kidney?
The operation is performed with a laparoscop. With partial resection, the surgeon removes only the cancer tissue inside the kidney, leaving the rest of the healthy organ inside the body. Any tissue removed from the patient’s body is sent to a pathological examination for examination under a microscope.

Partial or radical nephrectomy is an abdominal operation that is a “classic” treatment for a local kidney cancer (non-metastatic cancer). In most cases, a laparoscopic operation is performed. This is a minimally invasive surgical procedure that runs through several small cuts in the body (3-4 holes: one is performed near the navel, and the rest are in the lower abdomen and hip area), where the camera and delicate instruments are inserted. These cuts are performed instead of one large incision in the abdominal wall, which leaves a scar.

In some cases, depending on the patient’s health condition, the surgeon also removes some of the lymph nodes in the adjacent area. All removed tissues are sent to a pathological examination for examination under a microscope. Laparoscopy is much less traumatic, leading to a significant reduction in surgical wound, a reduction in post-operative pain and a reduction in recovery period. Thus, not only does the risk of infection decrease, but very small scars remain on the patient’s body. Removal of tissue from the abdominal cavity is carried out by placing it in a special bag inserted into the abdominal cavity through one of the cuts enlarged to a size of about 5-6 cm.

Which anesthesia will be used during the operation?

Laparoscopy is performed under general anesthesia.

How long does the operation last?

2-3 hours.

What are the indicators of the operation success and what are the risks?
It is important to know about the risks and complications that may occur during the operation of partial or complete kidney removal. To reduce them, the surgeon and anesthesiologist should be informed of the patient’s medical and personal experience. Surgical complications in both open and laparoscopic methods include bleeding, infection, damage to neighboring organs and the need for an open surgery.

During any laparoscopic operation, it may be necessary to go to an open surgery. This is not considered a surgical complication, but rather a correct surgeon’s decision. In general, the incidence of complications during and after laparoscopic surgery is low and it is much lower than during an open surgery, according to statistics.

How to prepare for surgery and hospitalization in Israel?
Please send medical documents issued by doctors in your country, including diagnosis, extracts, CT or MRI images, conclusions, a complete medical history and a list of medications that you take to ensure that our surgeon and anesthesiologist receive the most detailed medical information. Sometimes it becomes necessary to perform additional visual tests. As a rule, these can be CT of the chest, MRI of the abdominal cavity (magnetic resonance imaging), mapping of bones and mapping of the kidneys. Patients taking blood thinners, such as Aspirin and Warfarin, should inform us about this, as it is necessary to stop taking these medications several days before the operation.

What happens after surgery?
Upon completion of the operation, the patient is transferred to the recovery room to ensure a slow and safe recovery from surgery. Later the patient will be transferred to the Department of Urology. The medical staff helps him get out of bed and sit in a chair. The operation includes hospitalization for about 3 days. In the first days after surgery, the patient is in the hospital. If necessary, he is provided with painkillers. After 4-5 days after the operation, the patient can fly home.

What happens after discharge from the hospital?
Typically, the patient returns to normal daily activities and easy work in the office for 10 to 20 weeks.

It is important to keep clean the postoperative area, taking a shower every day with soap. In the first 6-8 weeks after the operation, it is recommended not to lift weights and do not perform energetic physical work.

If fatigue or dizziness is felt during this period, it is also advisable not to drive until these feelings pass. Sick leave is usually recommended for a period of 6 weeks. After completion of recovery after surgery, it is important that the patient has a “finger on the pulse”, should monitor the kidney function, take care with medication and consult the doctor about this.

Typical risk factors for kidney function are: consumption of weak alcohol, high toxicity (caused by different medicines), leading to kidney failure, uncontrolled hypertension, smoking.

Patients with a diagnosis of kidney carcinoma will be recommended to follow-up ultrasound of the kidney and CT of the thorax 6 months after the operation. After kidney laparoscopy, and in particular to patients after complete kidney removal, CT with low radiation and without contrast is recommended, in order to avoid damage to the remaining kidney.