Robotic partial nephrectomy

What is removed and what is preserved

Partial nephrectomy removes the tumour while leaving the remaining kidney in place. The operation may involve repair of blood vessels and the collecting system. Its feasibility depends on tumour location, size, complexity and the condition of the kidney.

The alternatives can include monitoring, ablation or radical nephrectomy, depending on the clinical circumstances.

Planning with imaging

Dr. Sachin’s work includes hilar tumours near the kidney’s main vessels and completely endophytic tumours located within its substance. A virtual 3D reconstruction can help map relevant anatomy; intraoperative ultrasound can help locate a tumour and define its relation to surrounding structures.

A cortical-window approach or tumour enucleation may be considered for selected anatomy. These are operative choices, not methods that are suitable for every tumour.

Clamping and kidney preservation

Temporary vascular clamping may be used to control bleeding while the tumour is removed. An off-clamp approach can be appropriate in selected cases. The decision balances visibility, blood loss, the safety of tumour removal and the function of the kidney.

“Off-clamp” should not be treated as a promise that every case will be safer or preserve more function.

Risks, pathology and follow-up

Important issues include bleeding, urine leakage, reduced kidney function, a positive surgical margin and the possible need for further procedures or removal of the kidney. The likelihood varies with the operation and the patient.

Bring the actual CT or MRI images, not only the written report, along with kidney function tests. Ask about the intended preservation strategy, possible changes to the plan and how the final pathology will be discussed.

Common questions