Editing Open Kidney Surgery (section)

== Pre-operative preparation ==

* '''Mechanical bowel preparation'''
** '''Not indicated for routine open renal surgery'''
** Indications for mechanical bowel preparation in open renal surgery (2):
**# Concern about intestinal involvement of a pathologic process
**# Iatrogenic intestinal trauma is likely because of multiple prior abdominal surgeries, with likely requirement of extensive lysis of adhesions.
* '''<span style="color:#ff0000">Venous thromboembolism prophylaxis</span>'''
** '''<span style="color:#ff0000">2008 AUA best practice statement: intermittent pneumatic compression is recommended in patients undergoing open procedures; consider addition of pharmacologic prophylaxis</span>[https://pubmed.ncbi.nlm.nih.gov/19152926/]'''
* '''<span style="color:#ff0000">Pre-operative antibiotics</span>'''
** '''<span style="color:#ff0000">2019 AUA guidelines: single dose cefazolin or TMP-SMX are recommended in all cases involving controlled entry into urinary tract (e.g. renal surgery, nephrectomy, partial or otherwise)</span>[https://pubmed.ncbi.nlm.nih.gov/31441676/]'''
**CUA guidelines: do not recommend  for renal surgery without involvement of collecting system
** Campbell’s 11th edition: A single dose of cefazolin or clindamycin for patients undergoing renal surgery with negative urine culture is prescribed.
* '''<span style="color:#ff0000">Renal artery embolization prior to nephrectomy</span>'''
** Relative indications (2):
***Aid in surgical dissection of large renal tumors
***Palliation of inoperable renal tumors in order to control bleeding for large locally advanced renal tumors.
** '''Potential benefits (5):'''
**# '''Shrinkage of an arterialized tumor thrombus to ease surgical removal'''
**# '''Reduced blood loss'''
**# '''Facilitation of dissection as a result of tissue plane edema'''
**# '''Modulation of immune response'''
**# '''Ability to ligate the renal vein before the renal artery'''
** '''Potential risks:'''
***'''Post-infarction syndrome, which includes flank pain, nausea, and fever'''
****'''Occurs in ≈75% of patients'''
***In some retrospective series embolization is associated with high blood loss, possibly due to the increased edema associated with the infarcted renal tissue
**'''Not utilized by all surgeons because potential risks may outweigh benefit'''