Korean J Urol.  2014 Sep;55(9):557-567. 10.4111/kju.2014.55.9.557.

Open Mini-Flank Partial Nephrectomy: An Essential Contemporary Operation

• Russo P
• Mano R

• KMID: 2069772
• DOI: http://doi.org/10.4111/kju.2014.55.9.557

Abstract

Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.

Keyword

Chronic kidney failure; Methods; Nephrectomy

MeSH Terms

Elective Surgical Procedures/adverse effects/*methods
Humans
Incidental Findings
Kidney Neoplasms/*surgery
Length of Stay
Nephrectomy/adverse effects/*methods
Postoperative Complications/prevention & control
Treatment Outcome

Figure

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  FIG. 1 "Mini-flank" surgical incision-8- to 10-cm extraperitoneal incision between the bed of the 10th and 11th rib.

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  FIG. 2 Intercostal ligaments are cut allowing more space between ribs and easy access to retroperitoneum.

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  FIG. 3 Ureter isolated in yellow vessel loop.

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  FIG. 4 Identification and isolation of the renal artery (red vessel loop) and renal vein (blue vessel loop).

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  FIG. 5 Regional ischemia provided using straight Satinsky clamp.

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  FIG. 6 Sharp scissor dissection of the tumor keeping the plane of surgical dissection within the normal kidney tissue.

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  FIG. 7 Direct collecting system repair.

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  FIG. 8 Argon-beam coagulator is used for hemostasis on the renal cortical surface.

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  FIG. 9 Placement of Floseal, Surgicel, and perinephric fat into renal cortical resection cavity.

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  FIG. 10 Closure of surgical incision in 2 layers using #1 polydioxanone, and reapproximation of the skin incision using 4-0 absorbable sutures in a subcuticular fashion.

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