What is included in postoperative care following a partial nephrectomy nephron-sparing surgery (NSS)?

Updated: Apr 01, 2019
  • Author: Reza Ghavamian, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

With adequate preoperative planning, meticulous surgical technique, proper patient selection, and attention to detail, NSS can be performed with minimal morbidity and excellent outcomes for most patients selected. The role of partial nephrectomy in the setting of metastatic disease and a solitary kidney is not clearly defined. Certainly, this operation is contraindicated in the presence of nodal metastases. The use of intraoperative adjuncts such as ultrasonography and, especially, frozen section analysis is invaluable to the operating surgeon for prompt and effective decision making. The placement of a closed suction drain is essential after NSS.

Use of the described techniques provides a watertight closure of large parenchymal defects. Certainly, other traditional methods of closure (eg, closure of the parenchyma with horizontal sutures over the length of the defect with fat or Oxycel or closure with Gelfoam and Surgicel bolsters) have been successfully used. These methods depend on the strength of the renal capsule. Use of Gore-Tex allows for even distribution of tension along the length of the closure. Small bleeding vessels are easily tamponaded. Gore-Tex also allows the surgeon to tie the sutures with the desired tension without risking tear of the kidney capsule, especially when the arterial clamp is removed in transverse resections carried out for larger tumors.

One concern about the use of exogenous material has been postoperative tissue reaction that might occur, particularly when a repeat resection is contemplated in the future. In the authors' experience, Gore-Tex is relatively unreactive, and, although a pseudocapsule forms, the subsequent explorations have not been difficult and the inflammatory tissue reaction around the Gore-Tex has been minimal.


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