Renal anatomy, physiology and its clinical relevance to nephrectomy

Prior to performing partial nephrectomy, the surgeon must closely review the vascular supply of the involved kidney. If multiple arteries are present, each should be clamped, individually or en bloc, to provide a bloodless field. Prior to clamping the renal vasculature, the availability and functioning of all instruments, clamps, hemostatic agents, sutures, clips, etc. should be checked. The surgeon should not waste precious time trying to gather supplies after the renal vasculature has been clamped. Appropriate patient selection for the initial portion of one’s learning curve is crucial. With experience, the surgeon can tackle more difficult tumor locations within the kidney, and WIT should decrease. Although traditional teaching emphasizes a WIT limit of 30 min, our goal should be to try to limit WIT as much as possible.