Open Partial Nephrectomy For A Small Renal Mass (Subcostal Incision)

Film presents a case of open partial nephrectomy (small portion of kidney removed) for a small renal tumor. This procedure is often performed as the initial step in the treatment of early stages of kidney cancer in which the tumor is removed with the surrounding adipose tissue. The indications for this nephron sparing surgery include: 1. Anatomical or functional solitary kidney affected with tumor. 2. Functional impairment of the contralateral kidney, in case when radical nephrectomy would worsen its function in the future. 3. Well-localized tumor of a limited size with a healthy contralateral kidney. Patient positioning and access to the kidney depend on the location of the tumor and eventually the necessity of warm ischemia with prompt securing of the renal vascular hilum. Approaching the kidney is possible through subcostal incision, midline laparotomy or lumbotomy without entering the peritoneal cavity. Small tumors located on the convexity of the lower pole can be accessed by the subcostal approach. As seen in the video, the patient is placed in the modified lateral flank position. Authors: Gabriel Varga MD, prof. Dalibor Pacik MD, Vitezslav Vit MD.