laparoscopic nephrectomy
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This section describes the procedure involved in having a nephrectomy, (removal of a kidney) You will have discussed the reasons behind having the surgery, which are to remove either a cancerous or a non-functioning benign kidney. At King's College Hospital we have for years carried out laparoscopic neprectomy and laparoscopic partial nephrectomy as a routine except for very large or complicated kidney cancers. We and other groups have shown laparoscopic nephrectomy to be superior to traditional open neprectomy from the point of view of blood loss, major complications and pain. The data available for cancer control appear at least as good as for tradidional nephrectomy For larger or more complex tumours, a traditional open operation may be recommended. | |
How is the operation carried out?
You will usually be prescribed a strong laxative to empty the bowel the day prior to surgery. This ensures the bowel is empty and gives a good view of the kidney area through the telescope. After luch on the day prior to the operation you should have no solid food. You will usually come in on the day of the operation and should starve for at least six hours prior to the scheduled operating time.
The operation is carried out under general (asleep) anaesthetic. Several small punctures are needed in the skin. A telescope is inserted into the abdomninal cavity and the abdomen filled with gas. Using long telescopic instruments the kidney is then mobilised and removed. If a tumour is present this will be by a small (2 inch) cut in the lower abdomen, but if the operation is for benign disease the kidney will usually be removed in pieces through one of the telescopic entry sites. The small wounds are closed with dissolving stitches and a drainage tube may or may not be left in the region of the kidney. A catheter tube is left in the bladder to allow accurate measurement of the urine for a day or so.
Following the operation it is usual to have mild discomfort only. Most patients will need only simple painkillers, but as in any surgery there may be more discomfort requiring strong painkillers.
Once the catheter is removed and the patient passes water he or she can usually leave hospital.
Despite the absence of a major cut in the skin, this is still a major operation. There is a risk of bleeding requiring blood transfusion of approximately 8-10%. urinary infection due to the catheter may occur. Rarely, bowel injuery or obstruction may necessitate repeat surgery. While we have had no deaths afeter this operation in our group there is a small risk of serious complications such as venous thrombosis or cardiac problems.
TIt is sensible to avoid heavy lifting and driving for tw to three weeks after the operation since any sudden increase in abdominal pressure can cause pain in the wounds.
You can return to work when you feel fit and depending on your job: usually two to three off are needed.
After any surgery you may feel tired and a bit emotional for a number of weeks. This is quite normal, but if you feel depressed it is important to let someone know.
If all goes smoothly a check in ten days or so will make sure there are no major problems and discuss the histology with a final operative check in about three months. Afterwards follow-up will be dictated by the original problem.
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