Laparoscopic Partial Nephrectomy

Laparoscopic Partial Nephrectomy (LPN) is a minimally invasive surgical procedure where only the diseased or damaged portion of a kidney is removed, preserving the rest of the kidney. It is often performed for localized kidney tumors, benign kidney masses, or other conditions that require the removal of part of the kidney while maintaining its function.

Indications

LPN is indicated for:

1. Kidney Tumors:
   • Small renal masses (typically <7 cm) that are localized and confined to the kidney.
   • Tumors in patients with hereditary conditions like von Hippel-Lindau disease.
2. Benign Kidney Lesions:
   • Angiomyolipomas or other benign masses causing symptoms.
3. Chronic Kidney Disease:
   • To preserve renal function in patients with a single kidney or reduced kidney function.
4. Trauma:
   • Localized kidney damage requiring partial removal.

Preoperative Preparation

1. Diagnostic Workup:

   • Imaging: CT or MRI scans with contrast to evaluate the tumor size, location, and vascular anatomy.
   • Blood tests: Kidney function tests (creatinine, eGFR) and complete blood count.
   • Biopsy: Optional for uncertain masses to confirm diagnosis before surgery.

2. Patient Counseling:

   • Discussion about the procedure, expected outcomes, potential risks, and recovery timeline.

3. Anesthesia:

   • General anesthesia is used during the procedure.

Surgical Procedure

1. Positioning:

   • The patient is placed in a flank position or lateral decubitus for optimal access to the kidney.

2. Port Placement:

   • 3-5 small incisions are made for laparoscopic ports, including one for the camera and others for surgical instruments.

3. Kidney Mobilization:

   • The kidney is exposed by dissecting surrounding tissues to isolate the affected area.

4. Tumor Resection:

   • The affected portion of the kidney is clamped to control blood flow (ischemia).
   • The tumor or damaged tissue is excised with precision, preserving as much healthy tissue as possible.

5. Reconstruction:

   • The remaining kidney tissue is sutured to close the defect.
   • Hemostatic agents or patches may be used to control bleeding.

6. Specimen Retrieval:

   • The removed tissue is placed in a retrieval bag and extracted through one of the incisions for pathological examination.

7. Closure:

   • The incisions are closed with sutures or surgical adhesives.

Postoperative Care

1. Monitoring:

   • Observation of vitals, kidney function tests, and urine output.
   • Imaging (e.g., ultrasound or CT) to confirm kidney function and absence of complications.

2. Pain Management:

   • Analgesics to address postoperative pain.

3. Early Mobilization:

   • Patients are encouraged to move early to prevent blood clots and speed recovery.

4. Pathology Results:

   • Tumor tissue is analyzed to confirm the diagnosis and guide follow-up care.

Benefits

• Preserves kidney function.
• Smaller incisions and less scarring.
• Reduced pain and faster recovery.
• Lower risk of chronic kidney disease compared to total nephrectomy.