Operative note 27 Advanced
Partial nephrectomy, open
What it does: cut the tumour out, keep the kidney.
- Wedge, cone, polar, or half. Plan first.
- Clamp the artery. Warm ischaemia, short. (Under 25 min. Go cold if longer.)
- Sharp cut. Sucker in the field.
- Fine prolene on vessels as you meet them.
- Frozen section from the bed.
- Keep a strip of capsule if you can. Helps closure.
- Sew the collecting system, 3/0, over a stent. Test with blue dye.
- Bolster (Surgicel) sewn into the defect.
- FloSeal paste. Drain.
- Watch: Never shave the margin to save the kidney.
- Watch: Leak or bleed more than after full removal.
- Watch: Drain fluid: send creatinine if it persists.
From the UroRef Operative Quick Guide.