Our Summary

This research paper is a review of different techniques used in a surgical procedure called renorrhaphy, which is a part of partial nephrectomy - surgery to remove part of the kidney. The review looked at 31 studies involving 5720 patients. There’s no agreement among surgeons on the best method of performing renorrhaphy. The review found that the use of some specific techniques, like barbed and running sutures, can reduce the ‘warm ischemia time’. This is the period when the kidney is deprived of blood supply during surgery, and keeping it as short as possible is important. The review also found that the use of hemostatic agents, which help stop bleeding, doesn’t have enough evidence to support its routine use. Some techniques, like not doing a stage called cortical renorrhaphy, could lead to minor complications and the benefits are still debated.

FAQs

  1. What is renorrhaphy and how is it related to nephrectomy?
  2. What techniques were found to reduce ‘warm ischemia time’ in kidney surgery?
  3. Is there conclusive evidence supporting the routine use of hemostatic agents in nephrectomy surgeries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about nephrectomy is to ask their surgeon about the specific techniques they plan to use during the procedure, and to inquire about how they will minimize warm ischemia time to protect the remaining kidney function. Patients should also discuss any potential risks or benefits of different renorrhaphy techniques with their surgeon.

Suitable For

Patients who are typically recommended for nephrectomy include those with:

  1. Renal cell carcinoma (kidney cancer) - Nephrectomy is often used as a treatment for renal cell carcinoma, especially in cases where the cancer is localized to the kidney and has not spread to other parts of the body.

  2. Large kidney stones - Nephrectomy may be recommended for patients with large kidney stones that cannot be effectively treated with other methods such as lithotripsy or ureteroscopy.

  3. Polycystic kidney disease - Nephrectomy may be recommended for patients with polycystic kidney disease, a genetic disorder characterized by the growth of numerous cysts in the kidneys that can lead to kidney failure.

  4. Kidney trauma - Nephrectomy may be necessary in cases of severe kidney trauma, such as a penetrating injury or a blunt force trauma that causes extensive damage to the kidney.

  5. Recurrent kidney infections - Nephrectomy may be recommended for patients with recurrent kidney infections that have not responded to other treatments and are causing significant damage to the kidney.

  6. Kidney donation - Nephrectomy may be performed in cases of living kidney donation, where a healthy individual donates one of their kidneys to a recipient in need of a kidney transplant.

Overall, the decision to recommend nephrectomy for a patient will depend on their individual medical history, the specific condition affecting their kidney, and the potential benefits and risks of the surgery. It is important for patients to discuss their options with their healthcare provider to determine the most appropriate treatment plan for their specific situation.

Timeline

Before Nephrectomy:

  1. Initial consultation with a healthcare provider to discuss symptoms and potential treatment options
  2. Pre-operative testing, such as blood tests and imaging scans, to assess the kidney and surrounding structures
  3. Pre-operative preparation, which may include fasting before surgery and taking medications as directed
  4. Anesthesia consultation to discuss the type of anesthesia that will be used during the surgery

During Nephrectomy:

  1. The patient is placed under anesthesia and the surgery begins
  2. The surgeon removes part or all of the kidney, depending on the reason for the nephrectomy
  3. Renorrhaphy techniques, such as suturing and hemostatic agents, are used to repair the kidney and stop bleeding
  4. The surgery typically lasts several hours, depending on the complexity of the case

After Nephrectomy:

  1. The patient is monitored in the recovery room for a period of time before being transferred to a hospital room
  2. Pain management is provided to help with discomfort from the surgery
  3. The patient may need to stay in the hospital for several days for observation and recovery
  4. Follow-up appointments with the surgeon are scheduled to monitor healing and discuss any further treatment or medications needed
  5. Rehabilitation and physical therapy may be recommended to help with recovery and improve kidney function

What to Ask Your Doctor

  1. What are the different techniques used in a nephrectomy procedure and which one do you recommend for my specific case?
  2. How will the chosen technique affect the warm ischemia time of my kidney during surgery?
  3. What are the potential risks and complications associated with the renorrhaphy procedure?
  4. Are there any alternative treatments or less invasive procedures that could be considered instead of a nephrectomy?
  5. How long is the recovery period expected to be after the surgery, and what kind of follow-up care will be needed?
  6. What are the expected long-term effects on kidney function after a partial nephrectomy?
  7. How often do you perform nephrectomy procedures, and what is your experience and success rate with the chosen technique?
  8. Are there any specific lifestyle changes or dietary restrictions that I should follow after the surgery to promote kidney health?
  9. What are the signs and symptoms of complications that I should watch out for after the surgery?
  10. Are there any ongoing clinical trials or research studies related to nephrectomy techniques that I should be aware of?

Reference

Authors: Daou S, Albeaini S, Mjaess G, Diamand R, Albisinni S, Roumeguère T, Aoun F. Journal: Minerva Urol Nephrol. 2023 Dec;75(6):683-695. doi: 10.23736/S2724-6051.23.05345-4. PMID: 38126283