A partial nephrectomy is a surgical procedure in which the cancerous part of the kidney is removed. This can be just as effective as removing the whole kidney (a nephrectomy) and is preferable whenever possible. In sporadic (non-hereditary) kidney cancer, this normally means that one tumour is removed. For someone affected by Birt-Hogg-Dubé syndrome, there may be several tumours present when the kidney cancer is found. In these cases, each tumour is cut out or removed from the kidney, leaving as much healthy kidney tissue as possible.
Your surgeon will determine if a partial nephrectomy is a suitable treatment. In some cases, the location or size of your tumour may make a partial nephrectomy infeasible. However, it is important that you ask your surgeon some questions before you schedule your kidney surgery:
- How many kidney surgeries have you performed this year? In total?
(Over 30 a year is good; over 100 a year is better)
- How many partial nephrectomies have you performed?
- How many laparoscopic partial nephrectomies?
- If you are telling me I need a full nephrectomy, why? Can nothing be done to save part of the kidney?
- How many patients have you had with tumours similar to mine?
Most urologists have training in performing nephrectomies. Technically, this is an easier operation to perform than a partial nephrectomy. However, since partial nephrectomies are preferable whenever possible for those with BHD, it is to your advantage to find an expert who can do a partial nephrectomy, even if it means travelling for the surgery.
Laparoscopic Surgery (Minimally Invasive Surgery)
Both full nephrectomies and partial nephrectomies can be done laparoscopically. This technique involves fewer incisions than traditional surgery, a shorter hospital stay, and usually a less painful, faster, and therefore easier recovery. Not all surgeons have experience with laparoscopic procedures, and you may have to seek a second opinion to find someone who can do this technique. For laparoscopic surgery, 3-4 small (1 cm) incisions are usually made in the abdomen, and a camera and narrow surgical instruments are inserted into the abdomen. The kidney or part of the kidney is placed in a bag and is removed via one of the incisions, which may be enlarged slightly to allow for this.
This surgery can be open, hand-assisted laparoscopic, or laparoscopic. Open surgery involves a flank incision, sometimes stretching from the side to within a few inches of the belly button. Sometimes part of a rib is removed. A hand-assisted laparoscopic nephrectomy involves a smaller incision than open surgery; however it needs to be large enough to allow the surgeon to insert their hands. More common these days is the laparoscopic nephrectomy.
Robotic Partial Nephrectomy
Currently, not all surgeons are experienced in doing partial nephrectomies. However, it is possible to perform extremely professional partial nephrectomies using robotic equipment. Doctors are also using these machines because they improve the precision, control and manoeuvrability that are needed during this type of surgery.
Natural Orifice Translumenal Endoscopic Surgery (NOTES)
This may, in the future, be an option for those facing kidney surgery, but it is still very new. It is a minimally invasive technique that combines laparoscopic and endoscopic techniques. Instead of making incisions in the body, the instruments for peritoneal cavity surgery are inserted through the body’s natural openings. The technique has the advantage of minimal scarring and a quick recovery time. NOTES has been performed on animals, and in a few cases, on humans. In 2010, Kaouk et al. reported a successful transvaginal donor kidney extraction on a 58-year old woman using NOTES. This may become an option for kidney removal in women. Kidneys have also been successfully removed via the navel, in what has been termed E-NOTES (embryonic natural orifice transumbilical endoscopic surgery) (Gill et al., 2008).