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May 2008 Issue

Krishnanath Gaitonde, MD, (left) and colleagues in the operating room.
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'Kidney-Sparing' Procedure Gives Patients More Options

By Amanda Harper
Published May 2008

In the past, a kidney cancer diagnosis almost always meant losing a kidney, leaving the patient with one functioning kidney and an increased risk of needing dialysis in the future.

But UC urologic surgeons say that is no longer the case.

They are among the first in Greater Cincinnati to offer—and have significant experience performing—what is known as “kidney-sparing surgery” to remove small cancerous tumors without sacrificing the entire organ, using minimally invasive techniques.

Kidneys are small, crescent-shaped organs that filter blood and remove waste products from the body via urine. People can live with one or part of one kidney, but if both organs are removed or dysfunctional the blood must be mechanically cleansed using a process known as dialysis.

Clinical data has shown that removing only the tumor and sparing the rest of the kidney is as effective as removing the entire organ in certain patients.

The UC team offers a number of kidney-sparing, minimally invasive surgical procedures for the treatment of small kidney tumors, including laparoscopic partial nephrectomy (removing part of the kidney) and laparoscopic cryoablation (freezing tumor tissue).

“Our goal is to maintain the kidney’s function so the patients have more options if the cancer recurs or if they develop any form of kidney disease later,” explains Krishnanath Gaitonde, MD, assistant professor of surgery at UC and minimally invasive urological surgeon with UC Physicians and University Hospital. “Once the tumor is removed, the kidney can heal and usually maintains function.”

Gaitonde says kidney-sparing surgery is usually performed for tumors that are 4 centimeters in diameter or smaller (about the size of a walnut) but can be done for larger tumors in special circumstances such as patients with decreased overall kidney function or those who have only one functioning kidney.

“Partial nephrectomy is a good option for younger patients with small kidney tumors who are otherwise healthy and can tolerate a significant operation,” says Gaitonde.

“Cryoablation is generally a better option for patients who are older or cannot tolerate traditional surgery due to other medical conditions.”

Cryoablation involves inserting
a needle into the center of the kidney tumor and subjecting it to extreme cold (minus 40 degrees Fahrenheit) to destroy the cancerous tissue and cells. The dead tumor tissue is left in place. After the procedure, the patient has regular imaging tests to monitor for cancer recurrence.

The procedure is still relatively new, however, and long-term data on cancer recurrence is limited so it is generally recommended for a select group of patients.

UC urologists are also evaluating the use of robotic surgery for performing these minimally invasive kidney procedures.
For more information, call (513) 475-8787.

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