Open Partial Nephrectomy

Open partial nephrectomy is a procedure in which part of the kidney is removed along with the surrounding tissue (normal), and the kidney is rebuilt for normal functioning. The main aim of this surgery is to save the functioning part of the kidney as much as possible as kidneys are the primary filters of the body.

The benefits of open partial nephrectomy include:

1. Lowest rate of severe complications (inadvertent kidney loss, postoperative bleeding)
2. Only a specific part is removed, unlike radical nephrectomy where the entire kidney is removed
3. Kidney functions are saved in case of individuals with one kidney or suboptimal kidney function

Individuals with the following conditions need open partial nephrectomy:

1. Injury 
2. Cancer in kidneys 
3. Damage by kidney stones
4. Infection in kidneys
5. High blood pressure since long causing damage to the kidneys
6. Birth defects

If the surgery is delayed, the condition may worsen, causing kidney failure

 

Your surgeon will:

1. Insert a urinary catheter to drain the urine out of the urinary bladder
2. Make a cut on the side or abdomen between the lower ribs and the affected kidney side
3. Block the blood vessel (temporary) that carries blood to the diseased kidney
4. Remove the tumour along with a rim of healthy tissue surrounding the tumour
5. Repair the kidney with stitches
6. Restore the blood supply to the kidney 
7. Seal the cut

The surgery can take three or more hours.

 

Before the surgery of open partial nephrectomy, you must:

1. Inform your doctor if you expect to be pregnant
2. Tell them about the medicines, vitamins, supplements, or herbs you are taking
3. Ask your doctor which medicines should be taken before and on the day of the procedure.

Your doctor will:

1. Take your blood sample (if blood transfusion is required)
2. Tell you to stop taking blood-thinning medicine such as aspirin, coumarin, naproxen, clopidogrel, etc.
3. Explain you the procedure of the surgery
4. Ask you to not smoke as it delays recovery.

You can expect the following on the day of surgery:

Your doctor will:

1. Tell you when to come to the hospital
2. Review your medications and history
3. Ask you to complete the consent formalities
4. Discuss the surgery in short with you
5. Instruct to take medicines with a small sip of water

1. Position during surgery: You will be made to lie on one side depending on which kidney is to be operated on.
2. Cleaning and Draping: 
   1. Proper cleaning and draping will be done to protect your privacy and comfort.
   2. The doctor may inject heparin solution and give you a pair of TED (Thrombo-Embolus Deterrent) stockings to prevent blood clotting.
3. Anaesthesia: The surgery is performed under general anaesthesia.

Depending on the procedure, you might stay in the hospital for one to seven days.

The recovery process in Hospital:

You will:

1. Be told to sit on the edge of the bed and walk on the same day of your procedure
2. Have a catheter or tube coming from your bladder to drain your urine
3. Be told to do breathing exercises 
4. Not be able to eat solid foods for one to three days 
5. Told to wear compression boots, unique stocking, or both to prevent blood clotting
6. Be given blood-thinning injections
7. Be given pain-relieving medicines

The recovery process after hospital discharge:

You will:

1. Be told to avoid heavy lifting and strenuous activity for six weeks after the surgery.
2. Have pain in the surgical area which will subside over several weeks (pain-relieving medicines will be prescribed).
3. Mostly completely recover after three to four weeks
4. Be able to resume work at the end of the third to fourth week

Your doctor will arrange your first follow-up appointment after seven to ten days to remove your stitches or staples.

 

When to Consult a Doctor?

Possible side effects that can occur after the surgery are:

1. Breathing problems
2. Blood loss
3. Blood clots in the legs may travel to the lungs
4. Reaction to medications
5. Allergic reactions to anaesthesia (rare)
6. Kidney failure (depends on the functioning of the remaining kidney) 

Risk/complications:

1. Injury caused to other organs
2. Hernia of your surgical area
3. Kidney failure in the remaining kidney
4. Infection in the surgical area, kidney, bladder, or lungs (pneumonia)