HREBINKO Partial Nephrectomy (open)

Preop:

ancef, bowel prep;

make sure argon beam and tisseel in room

pcn allergy cipro

1. position iliac crest at table break

2. shave pt, foley

3. prep

4. two finger breaths below costal margin, make 8-10cm incision

5. use bovie to cut thru rectus abdominis and thru fascia (avoidcutting latisimmus dorsi)

6. lysis of adhesions

6a. Bookwalter post opposite side of incision

7. dissect out kidney by first freeing up colon and then otherperirenal attachments

8. locate ureter and renal a and v so that a vascular clamp can beused if needed (do not clamp ureter) for hemostasis

9. locate tumor and bovie 5mm ring around it

10. use right angle to develop plane between normal parenchyma and tumor

11. use finger nail technique to enucleate tumor (expect much bleeding)

12. hold pressure and assess margins of specimen

13. obtain 4 or 5-0-polysorb on a pledget

14. make sure to get large bite (must catch capsule otherwise will rip thru)

15. save perirenal fat for “plugging” up enucleation hole and tiepledgeted suture to hold fat in place for hemostasis

16. check for hematuria

17. irrigate

18. spray tisseel onto wound

19. place paracolic gutter drain near kidney to check for leak

20. close posterior rectus fascia with small bite 0-polysorb running

21. close anterior rectus sheath with large bite 0-polysorb running

22. 2-0 vircryl “fat boy”

23. staple

– POD#1: d/c foley

– POD#2: check JP Cr; d/c JP

d/c staples before d/c home