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Surgery Insight: advances in techniques for open partial nephrectomy

Nature Clinical Practice Urology volume 4, pages 444–450 (2007)Cite this article

Abstract

With the widespread use of abdominal imaging, there has been a substantial increase in the detection of incidental, small renal masses. This change has resulted in a downward trend in the size and stage of tumors being detected, and a corresponding increase in the number of renal cortical tumors amenable to partial nephrectomy. Based solely on a size criterion of 7 cm or less (pT1), nearly 70% of all patients with newly diagnosed kidney tumors are eligible for partial nephrectomy. Here, we briefly review the current rationale for partial nephrectomy and provide insight into advances in the technique of open partial nephrectomy. In addition to describing in detail the surgical techniques used at our institution, we also report the outcomes of our series of open partial nephrectomies performed via a mini-flank incision above the 11th rib. We believe that this approach offers a safe, practical and easily adoptable alternative to traditional open partial nephrectomy and laparoscopic partial nephrectomy.

Key Points

  • Despite equivalent oncologic results and renal functional advantages, partial nephrectomy continues to be underused for the treatment of small kidney tumors

  • Laparoscopic partial nephrectomy is an extremely challenging operation and associated with a greater risk of postoperative complications than open partial nephrectomy, even in expert hands

  • Open partial nephrectomy via a supra-11th rib mini-flank incision provides the safety and control of open surgery while reducing the morbidity associated with traditional open incisions

  • Open partial nephrectomy via a supra-11th rib mini-flank incision is a contemporary alternative to traditional open or laparoscopic partial nephrectomy and can easily be adopted by any surgeon comfortable with open renal surgery

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Figure 1: Positioning patients for supra-11th rib mini-flank incision open partial nephrectomy
Figure 2: The incision for the supra-11th rib mini-flank open partial nephrectomy approach
Figure 3: Exposure of the retroperitoneal space after incision via the supra-11th rib mini-flank approach
Figure 4: Mobilization of the upper pole of the kidney
Figure 5: Dissection of the renal hilum
Figure 6: Excision of the tumor
Figure 7: Frozen section analysis
Figure 8: The appearance of the supra-11th rib mini-flank incision after closure

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Authors and Affiliations

  1. and P Russo is an Attending Surgeon in the Department of Surgery (Urology) at the Memorial Sloan–Kettering Cancer Center, WC Huang is Assistant Professor of Urology at NYU Medical Center, MA Kagiwada is a Research Assistant, New York, NY, USA.,

    William C Huang, Megan A Kagiwada & Paul Russo

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  1. William C Huang
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  2. Megan A Kagiwada
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  3. Paul Russo
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Correspondence to Paul Russo.

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The authors declare no competing financial interests.

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Huang, W., Kagiwada, M. & Russo, P. Surgery Insight: advances in techniques for open partial nephrectomy. Nat Rev Urol 4, 444–450 (2007). https://doi.org/10.1038/ncpuro0855

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