Nephrectomy, partial
CPT4 code
Name of the Procedure:
Partial Nephrectomy (also known as Partial Kidney Removal, Nephron-Sparing Surgery)
Summary
A partial nephrectomy is a surgical procedure to remove a part of the kidney affected by a tumor or damaged tissue. The healthy portion of the kidney is preserved, which helps maintain kidney function.
Purpose
Partial nephrectomy is primarily used to treat kidney tumors or cancers. The goal is to remove the diseased portion of the kidney while retaining as much healthy tissue as possible to ensure continued renal function.
Indications
- Presence of a small, localized kidney tumor.
- Benign kidney masses that may cause symptoms or grow over time.
- Kidney conditions where preserving kidney function is crucial.
- Patients with only one kidney or at high risk of developing kidney disease.
Preparation
- Patients are usually instructed to fast for several hours before the procedure.
- Any current medications may need adjustment, especially blood thinners.
- Preoperative diagnostics may include blood tests, urine tests, imaging studies (CT or MRI scans), and discussions about medical history.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A small incision is made in the abdomen or side, or several small incisions are made if using laparoscopic surgery.
- Accessing the Kidney: The surgeon obtains access to the kidney through the incision.
- Tumor Removal: The part of the kidney with the tumor or damaged tissue is carefully removed.
- Repairing the Kidney: The remaining kidney tissue is sutured to ensure proper function.
- Closure: The incision(s) are closed with sutures or staples.
The procedure may use specialized tools, including surgical instruments and possibly robotic technology.
Duration
The procedure typically takes between 2 to 4 hours, depending on the complexity and surgical technique used.
Setting
Partial nephrectomies are performed in a hospital's operating room or a specialized surgical center.
Personnel
- Lead Surgeon (Urologist or Oncologist specializing in kidney surgery)
- Assistant Surgeons
- Anesthesiologist
- Operating Room Nurses
- Scrub Technicians
Risks and Complications
- Infection
- Bleeding
- Blood clots
- Damage to surrounding organs or tissues
- Decreased kidney function
- Urine leakage from the surgical site
- Rarely, the need for further surgery
Complications are managed through prompt medical intervention and supportive care.
Benefits
- Effective removal of cancerous or damaged tissue
- Preservation of kidney function
- Potential cure or control of kidney tumors
- Improved quality of life
Benefits are often noted shortly after recovery, with improved renal health and reduced symptoms.
Recovery
- Hospital stay of 1-5 days, depending on the patient's condition and surgical approach.
- Pain management with prescribed medications.
- Limited physical activity for several weeks.
- Follow-up appointments to monitor healing and kidney function.
Most patients return to normal activities within 4-6 weeks, with specific instructions on activity restrictions.
Alternatives
- Radical nephrectomy (complete kidney removal)
- Ablation techniques (radiofrequency or cryoablation)
- Active surveillance for small, asymptomatic tumors
Each alternative has its pros and cons, such as the potential for more significant loss of kidney function with radical nephrectomy or the watch-and-wait strategy of active surveillance.
Patient Experience
Patients can expect to feel soreness and discomfort around the incision site postoperatively. Pain is generally well-managed with medications. During recovery, patients may experience temporary restrictions on activities, but overall discomfort should diminish as healing progresses. Supportive care, including pain management and physical therapy, helps ensure a smoother recovery.