Nephron Sparing Surgery !!

Q. Can someone elaborate the terms

"Wedge resection"
"Standard Partial Nephrectomy"
With respect to nephron sparing surgery?

Q. When to perform which one? (If peculiarly indicated)

Q. What is the current status on bolstering the renal parenchymal after PN? How does it work?


  • Nitesh Jain
    Nitesh Jain
    20 May 2020 08:10:20 PM

    Encleation - basically it is aimed to preserve the maximum parenchyma in patient with multiple tumors, hilar tumor, patient with CKD or solitary kidney. the tuor is basically the tumor pseudocapsule peeled off the normal parenchyma using blunt dissection. with a belief that a single cell negative margin is enogh for good oncological outcome. quite a few studies supports the claim. personally i do belive that it can result in higher Positive surgical margin. the other claim made by the proponent of the enuleation is less blood loss as pseudocapsule is just dissected off the parenchyma. but at times in small tulmor sometime there may not be any pseudocapsule which can again be the reason for higher postive margin

    enuleaoresection - taking out the tumor with a thin rim of normal tissue thus preserving the max parechyma but definetly less than enucleation but possibly with less PSM

    wedge resection and standard PN - needs no mention

    bolstering is a personal preferece and off late i have stopped using it. various hemostatic agent like abgel, surgicel, surgicel snow, even abdominal fat are used which act as filling the defect and giving a tamponade effect in addition to activating the hemostatic mechanism in the raw parenchyma

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