Nephron sparing surgery (NSS)

Benefits:

The expected outcome of NSS is the treatment of neoplasm

Indications and contraindications:

  Indications:
  • The NSS procedure is recommended for patients with a diagnosis of a kidney tumour or cyst of suspected neoplastic nature if the lesion is located in a place suitable for this type of procedure and its transverse dimension does not exceede 5 or 6 cm.
  • The focal lesion must be confirmed by a CT scan.
  Contraindications:
  • the patient has blood clotting disorders,
  • anticoagulant medications should be discontinued or replaced with other medications. Before the procedure please tell your doctor about all medications you take,
  • NSS is not possible due to the tumour location.

FAQ

When can I resume normal physical activity after the procedure?

We recommend resting and limiting physical exertion during the first 4 weeks after the surgery and avoiding physical activity for 14 days after the surgery.

Is the NSS procedure sufficient to treat kidney cancer or will I need further treatment?

If the histopathological examination of the surgical margin confirms that the tumour has been completely removed, there are no indications for further oncological treatment (chemo- or radiotherapy).

Before the procedure:

Two weeks before the procedure you should have the following blood tests done: full blood count, electrolyte test, coagulation test, blood type, glucose, creatinine, Hbs antigen, ANTI-HCV.

Procedure:

The procedure is performed as an open surgery or, in selected cases, as a laparoscopic surgery.
The open NSS procedure is performed under general anaesthesia. The decision is taken by an anaesthetist before the procedure.
During the procedure the tumour is removed (enucleated) or resected with a surgical margin (wedge resection).
The skin incision is oblique and is located either at the side or along the costal arch, with the patient lying on the back. The material collected during the procedure (tumour tissue) is sent for histopathology testing.
This is the procedure when the tumour is removed while sparing the kidney.

After the procedure:

  • After the surgery you may feel pain in the wound area, but it will be alleviated by painkillers.
  • A catheter will remain in the bladder for a few days. Also, a drain will be placed in the wound.
  • The NSS procedure is relatively safe, but complications may happen. These include: intra- and post-operative bleeding requiring blood transfusion or kidney removal, infection, prolonged wound healing caused by infection, the need to leave the drain in the wound for a longer time, post-operative urinary tract infection, urethral stricture after the use of the catheter. If kidney parameters (creatinine, urea, electrolytes) are increasing, it may be necessary to perform a haemodialysis until the normal kidney function is restored (e.g. if the procedure was done on the patient’s only kidney).
  • After the catheter is removed you may feel pain and burning in the urethra and bladder.
  • Usually, patients are mobilised on the 2nd day after the surgery.
  • After the discharge from the hospital (about 5 days after the procedure) you should take care of the post-operative wound and change the wound dressing by yourself.
  • A follow-up visit 7 days after the procedure is recommended to remove the stitches, evaluate the treatment and talk about histopathology results.
  • During the post-operative period we recommend an assessment of blood biochemistry parameters about 14 days after the procedure.
  • A follow-up ultrasound scan every 3 months is recommended. A CT scan should be done half a year after the surgery.
  • A lung x-ray should be done once a year.

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Wielkopolskie Centrum Medyczne
Sp z o.o. S.K.A

st. Bolesława Krzywoustego 114
61-144 Poznań, POLAND

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