Bilateral tumours:
- Strongly consider biopsy
- ?Genetic syndrome
- ?Metastases
- ?Lymphoma
- Consider approach – simultaneous partials vs easy side first vs complex side first
- Erring towards difficult side first
- Bilateral nephrectomy and dialysis is an option (clearly not ideal)
Imperative partials – things to consider
- Biopsy is mandatory – don’t do a risky technically difficult partial for a benign tumour
- Is this cross renal metastasis (nephrectomy for RCC in other kidney)? – if so, look for other mets.
- Open is the default approach
- Consider bench surgery with cooling and auto-transplant
Tumour in a transplant kidney:
- Biopsy probably mandatory
- Incidence 2 – 5 %
- Low tolerance for a radical nephrectomy and back to dialysis
- Open approach
- Consider partial nephrectomy only if “easy”
- Renal team involvement
- OK to continue immunosuppression
Horseshoe – heminephrectomy or partial nephrectomy, midline incision, aberrant vasculature +++ makes it difficult, isthmus usually not too vascular – take it as a wedge to allow closure.