Wiki Radical Nephrectomy VS Nephrectomy with Partial Uretrectomy

[sclontz]

Hi
Im looking a Urology Coder for clarification on the Radical Nephrectomy VS Nephrectomy with Partial Uretrectomy. Below is CDR from Solventum (3M). What I find have found is the Gerota's facia, adrenal gland are not always removed in a Radical Nephrectomy, as stated in the CDR below. With that being said, I do not understand the difference between the Radical nephrectomy and the total nephrectomy with ureterectomy . Can anyone assist me and possibly provide resources?
Thank you



50545 Radical Nephrectomy
The physician performs a radical nephrectomy, including removal of Gerota's fascia and surrounding fatty tissue, regional lymph nodes, and the adrenal gland through a laparoscope. The physician makes a 1 centimeter periumbilical incision and inserts a trocar. The abdominal cavity is insufflated with carbon dioxide. A fiberoptic laparoscope fitted with a camera and light source is inserted through the trocar. Other incisions (ports) are made in the abdomen or flank to allow other instruments or an additional light source to be passed into the abdomen or retroperitoneum. The colon is mobilized, and the laparoscope is advanced to the operative site. The ureter is transected at the ureterovesical junction. The physician clamps, ligates, and severs the renal vein and renal artery. The Gerota's fascia is dissected to expose the upper pole of the kidney. The adrenal gland is visualized. Clips are placed on the suprarenal vein and adrenal arteries (diaphragmatic [inferior phrenic], aortic, and renal) which are cut. Any lymph nodes in the surrounding area are excised and removed. The kidney, adrenal gland, renal (Gerota's) fascia, and surrounding fat are dissected free; they are bagged and removed through an enlarged port site. The instruments are removed. The incisions are closed with staples or suture.

50548 Lap Nephrecotmy with Total Ureterectomy
The physician removes the kidney and all of the ureter through a laparoscope. The physician makes a 1.0-centimeter periumbilical incision and inserts a trocar. The abdominal cavity is insufflated with carbon dioxide. A fiberoptic laparoscope fitted with a camera and light source is inserted through the trocar. Other incisions (ports) are made in the abdomen or flank to allow other instruments or an additional light source to be passed into the abdomen or retroperitoneum. The colon is mobilized and the laparoscope is advanced to the operative site. The physician mobilizes the kidney and clamps, ligates, and severs the all of the ureter at the ureterovesical junction and major renal blood vessels (renal pedicle). The kidney and ureter are bagged and brought through one of the port sites (e.g., periumbilical) that has been slightly enlarged. The instruments are removed, and the small abdominal or flank incisions are closed with staple or suture

50546
The physician removes the kidney and a portion of the ureter through a laparoscope. The physician makes a 1 cm periumbilical incision and inserts a trocar. The abdominal cavity is insufflated with carbon dioxide. A fiberoptic laparoscope fitted with a camera and light source is inserted through the trocar. Other incisions (ports) are made in the abdomen or flank to allow other instruments or an additional light source to be passed into the abdomen or retroperitoneum. The colon is mobilized and the laparoscope is advanced to the operative site. The physician mobilizes the kidney and clamps, ligates, and severs part of the ureter and major renal blood vessels (renal pedicle). The kidney and upper ureter are bagged and brought through one of the port sites (e.g., periumbilical) that has been slightly enlarged. The instruments are removed, and the small abdominal or flank incisions are closed with staples or suture.

 

[sclontz]

Submitting an OP report. Can this be considered a Radical Nephrectomy?

A right lower quadrant Gibson incision was made with a #15 blade and Bovie cautery. Peritoneum was opened carefully with Metzenbaum scissors. An Alexis robotic GelPort was placed and the abdomen was insufflated to 15 mmHg. A 8 mm port was introduced through this port and the abdomen surveyed. No intraabdominal damage was appreciated. A series of three additional 8 mm robotic ports were placed in a straight line paramedial standard fashion, in addition to a 12 mm airseal assistant port.

Robotic scissors and robotic bipolar cautery were inserted now under direct vision and I began the dissection. The white line of Toldt was mobilized to free up the kidney and then the reno-colic ligament was divided to reflect the colon off the kidney. Gerota's fascia was left attached to the kidney and is removed with the kidney specimen.

The lower pole was dissected to identify the the ureter. These structures were dissected and followed up to the kidney to identify the renal hilum. The vein and renal artery were then isolated. The renal artery branched into an anterior and posterior branches that were stapled separately. A vascular stapler was then used to divide these structures with excellent hemostasis. The more posterior renal vein was identified and ligated with Hem-o-lok clips. The upper pole attachments were then freed using the vessel sealer. The lower pole was then divided with vessel sealer along with the ureter. The gonadal vein was never identified. The kidney was now completely free.

Tisseel fibrin glue was poured over the renal fossa and over the hilum to aid with postoperative hemostasis.

The colon was carefully inspected with no evidence of injury. The robot was undocked and pulled away. A 12 mm endo bag was inserted and the kidney was attempted to be placed into the bag but it was too large. The remaining ports were now removed. The right lower quadrant Gibson incision was expanded and the kidney specimen was brought out intact manually. The fascia was closed with 0 looped PDS suture. Subcutaneous fat was closed with 3-0 Vicryl suture. Skin was closed subcuticular fashion with 4-0 Monocryl. The 12 mm port site was closed at the fascial level with a zero vicryl on a UR-6 needle. All ports sites were injected with local anesthetic and skin was reapproximated using 4-0 monocryl. Sterile dressings were applied. The patient was extubated and returned to the recovery room in excellent condition.