Right Laparoscopic Partial Nephrectomy

To finish the procedure:

Specimen bagging may be performed either at the end of the procedure or at the time of excision, if there are oncological or procedural risks involved. We generally complete excision and leave the specimen in an area of the field where it is easy to find and does not bother during renorraphy. As we said

Once we complete renorraphy we try to close Gerota’s fascia-peritoneum. The closure of Gerota’s fascia has a triple objective: First, get back the kidney to its original positionSecond, to cover the renal surgical field with a layer of perirrenal fat, contributing to hemostasis.Third, to fix the kidney which was mobilized for optimal performance. Gerota’s fascia

Pedicle clamping is a very important part of partial nephrectomy. By clamping we suppress, completely or partially, the inflow of blood into the kidney, and by doing so we can perform tumor excision and surgical bed repair/hemostasis with good control and less bleeding. The variety of case scenarios in partial nephrectomy is wide. From off

We usually perform a two-layer renorraphy. The first suture, the deep surgical bed layer, has the objective of closing the urinary tract and to perform hemostasis of the main vessels. We generally perform it under ischemia, so we add the pressure of warm ischemia time to the difficulties of suturing the parenchymal breach. The most

The objectives of tumor excision are: To obtain the complete tumor keeping a margin of healthy renal tissue around To spare the maximum healthy renal parenchyma. The main risk is to enter the tumor leaving a positive surgical margin or seeding tumor cells in the field. Another risk, not as important, is to take excessive normal parenchyma. Preliminary considerations

Once we expose the tumor and normal parenchyma around the kidney we proceed to score the margins to help tumor excision. Partial nephrectomy must be oncologically safe. Thus, the tumor comes out surrounded by a margin of healthy tissue. Traditionally this margin was as wide as 5 mm, but several studies have demonstrated that smaller

This phase has two main objectives Tumor identificationExposition of a safety area of normal renal parenchyma around the tumorThe first objective, identification of the tumor, is of the utmost importance but not always easy. Intracavitary ultrasound is recommendable. Many tumors, like the one in figure 8.1, are easily visible even from the beginning of the