What is laparoscopic nephrectomy surgery?
Before the laparoscopic nephrectomy surgery
What happens during the laparoscopic nephrectomy surgery?
How long will the laparoscopic nephrectomy surgery take?
After the laparoscopic nephrectomy surgery (recovery)
Risks and complications of laparoscopic nephrectomy surgery
What can I expect after laparoscopic kidney surgery?
Is nephrectomy a major surgery?
Laparoscopic nephrectomy is a minimally invasive technique, so when compared to conventional open surgery, it can mean significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes identical to that of open surgery.
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Nephrectomy (nuh-FREK-tuh-me) is a surgical procedure to remove all or part of a kidney:
- Radical (complete) nephrectomy.During a radical nephrectomy, the urologic surgeon removes the entire kidney and often some additional structures, such as part of the tube that connects the kidney to the bladder (ureter), or other adjacent structures such as the adrenal gland or lymph nodes.
- Partial nephrectomy.In a partial nephrectomy, also called kidney-sparing (nephron-sparing) surgery, the surgeon removes diseased tissue from a kidney and leaves healthy tissue in place.
Most often a nephrectomy is performed to treat kidney cancer or to remove a noncancerous (benign) tumor. In some cases, a nephrectomy is performed to deal with a diseased or seriously damaged kidney. In the case of a donor nephrectomy, the urologic surgeon removes a healthy kidney from a donor for transplant into a person who needs a functioning kidney.
The urologic surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen using a camera and small instruments (laparoscopic nephrectomy).
In some cases, these laparoscopic procedures are performed using a robotic system. In robotic surgery, the surgeon sits at a computer console near the operating table. He or she controls the camera arm and mechanical arms, which have surgical instruments attached to them that are working inside the patient's body.
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Before the laparoscopic nephrectomy surgery
If you take blood thinners such as warfarin, aspirin, or plavix, your surgeon will instruct you to stop taking those 5 to 7 days before surgery. Anti-inflammatory medications and certain vitamin supplements can cause increased bleeding so disclose all of your medications and supplements to your surgeon and anesthesiologist.
It is very important that in preparation for your surgery that you stop smoking. Tobacco hurts the body's natural ability the heal itself which is very important after laparoscopic kidney surgery.
Your surgeon will ask you to not eat or drink anything after midnight the night before your surgery. This is to prevent negative effects of the potential nausea that some patients experience due to anesthesia. Your surgeon may instruct you to take your blood pressure medicine the morning before surgery and you may do so with small sips of water.
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What happens during the laparoscopic nephrectomy surgery?
- Laparoscopic Surgery
Some people who require a nephrectomy are suitable for laparoscopic surgery (also called minimally invasive surgery) to remove the kidney. Laparoscopic surgery involves the use of a laparoscope (wand-like camera) that is passed through a series of small incisions or “ports” in the abdominal wall. It is used to view the abdominal cavity and remove the kidney through a small incision. The procedure is done under general anesthesia (you are asleep and do not feel any pain). You will require a bladder catheter that is placed once you are asleep and is removed several hours after surgery.
Laparoscopy achieves the same things as traditional surgical techniques and can be used for both radical and partial surgery. It is also the preferred method for kidney transplant donor nephrectomy.
The advantages of laparoscopic surgery include:
- Shorter recovery time
- Shorter hospital stay
- Smaller incisions
- Fewer post-operative complications
Laparoscopic nephrectomy takes special skills to perform and is not available at all hospitals. Also, whether you can have laparoscopic surgery depends on your medical condition and overall health. Speak to your doctor about your options for laparoscopic nephrectomy.
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- Open Nephrectomy
Open nephrectomy is rarely required but is also done under general anesthesia. The surgeon makes a cut (incision) in the abdomen or in the side of the abdomen (flank area). A rib may need to be removed to perform the procedure. The ureter (the tube that carries urine from the kidney to the bladder) and the blood vessels are cut away from the kidney and the kidney is removed. The incision is then closed with stitches.
- Radical nephrectomy.In a radical nephrectomy, the surgeon removes the whole kidney, the fatty tissues surrounding the kidney and a portion of the tube connecting the kidney to the bladder (ureter). The surgeon may remove the adrenal gland that sits atop the kidney if a tumor is close to or involves the adrenal gland. In some cases lymph nodes or other tissues are removed as well.
- Partial nephrectomy.In a partial nephrectomy also called kidney-sparing (nephron-sparing) surgery the surgeon removes a cancerous tumor or diseased tissue and leaves in as much healthy kidney tissue as possible.
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- Robot-assisted laparoscopic surgery.In a variation of laparoscopic surgery, the surgeon uses a robotic system to perform the procedure. Robotic tools require very small incisions, provide better 3-D images during the procedure, and can make fine or complex motions that are similar to what a surgeon's hand can do in open surgery.
How long will the laparoscopic nephrectomy surgery take?
The operation usually takes about 2-3 hours, but can vary depending on the individual case.
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After the laparoscopic nephrectomy surgery (recovery)
You will wake up from your operation in the recovery room of theatres (although you may not remember this). The recovery room staff will look after you until you are ready to return to the ward. You will have intravenous fluids (drip) into your arm which will give you fluid until you can drink normally. You can have some oral fluids fairly soon after the operation, but you should be drinking normally by the next day. You can have something light to eat usually by the next morning.
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Risks and complications of laparoscopic nephrectomy surgery
- Scar
You can expect between 3 and 5 small scars at different points on your abdomen.
- Dressings
You do not need to keep the scars covered though some people find it more comfortable to do so. You do not need to worry about getting your scars wet and may bathe or shower as usual.
- Discomfort
You will experience some pain and discomfort around the scars, especially in the first week after surgery.
Your body is using a lot of energy to heal itself, so you will feel more tired than normal.
- Temporary pain in the tip of your shoulder.
- Temporary bloating of your tummy.
- Bleeding, infection, pain or hernia of the incision needing further treatment.
- The pathology may turn out not to be cancer.
- Recognised (or unrecognised) injury to organs/blood vessels needing conversion to open surgery (or deferred open surgery).
- Involvement or injury to nearby local structures (blood vessels, spleen, liver, kidney, lung, pancreas, bowel) needing more extensive surgery.
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission
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What can I expect after laparoscopic kidney surgery?
- Pain control: You can expect to have some pain that may require pain medication for a few days after discharge. Afterward, Tylenol should be sufficient to control your pain.
- Showering: You may shower after returning home from the hospital. Your wound sites can get wet but must be padded dry immediately after showering. Tub baths are not recommended in the first two weeks after surgery as this will soak your incisions and increase the risk of infection. You may have adhesive strips across your incision. These are not to be removed. They will fall off in approximately five to seven days. Sutures will dissolve in four to six weeks.
- Activity: Taking daily walks is strongly advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible but should be taken slowly. Driving should be avoided for at least one to two weeks after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) for six weeks or until instructed by your doctor. Most patients return to full activity on an average of three weeks after surgery. You can expect to return to work in approximately four weeks.
- Diet: You should drink plenty of fluids and discuss with your doctor if you need to be on a salt- or protein-restricted diet.
- Pathology results: The pathology results from your surgery are usually available in one week following surgery. You may discuss these results with your surgeon by contacting him by phone or in your follow-up appointment in the office.
- Kidney function blood tests and X-rays: Patients are encouraged to have an annual blood test, called serum creatinine, performed by their primary care physician to follow their overall kidney function. Your surgeon will also review these results in the office during follow-up visits. In patients with kidney tumors, follow-up X-ray tests (e.g., CT, MRI, sonograms) may be periodically required to follow the appearance of your remaining kidney.
Is nephrectomy a major surgery?
A nephrectomy is a major surgery to remove all or part of your kidney. The kidneys are two small, bean-shaped organs in the abdomen. They filter water and waste products from your blood.
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