How is hemorrhage treated 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

The most troublesome and common intraoperative complication of partial nephrectomy is excessive bleeding. In this respect, meticulous dissection, attention to detail, and ligation of intraparenchymal vessels are of paramount importance. Easy access to the renal hilum, provided by early identification and isolation of the renal artery, provides the additional safety of prompt arterial occlusion when excessive bleeding precludes a clear surgical field and adequate visualization. Postoperative hemorrhage is usually self-resolving and may be confined to the retroperitoneum or may be present with gross hematuria, decreased hematocrit, or flank ecchymosis. Treatment is expectant, consisting of volume resuscitation, serial hematocrits, and bedrest. Embolization is an option in the unusual case in which bleeding persists after conservative management and requires multiple transfusions. Reexploration is the last resort for severe intractable bleeding.

Not only is the intraoperative risk of bleeding relatively high (5-25%) with laparoscopic and/or robotic partial nephrectomy but the postoperative hemorrhage risk is not insignificant (1-15%). Mitigating this risk is very important for those surgeons performing this procedure, and the first step in doing so is identifying these risk factors. Richstone and colleagues present an overview of predictors that surgeons should be familiar with prior to performing this surgery and when counseling these patients prior to surgery. [4] Smoking and high American Society of Anesthesiologists (ASA) score were noted as risk factors for hemorrhagic complications in this study.


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