Laparoscopic Nephrectomy / Robotic Nephrectomy
Laparoscopic Nephrectomy / Robotic Nephrectomy is the minimal invasive surgery or the Key Hole surgery. It is a safe and effective way of removing a kidney and the results are comparable with the open surgery. It has the advantage of the minimal invasive surgery in the form of less pain, shorter hospital stay, smaller scar, better cosmesis, and early return to work.
What to expect during you preoperative consultation
In the first consultation with the surgeon, he usually reviews all the documents, images and investigation. He does a physical examination and Asses the fitness for the surgery. If there is a renal tumor, the surgeon would like to stage the disease. Once the surgery date is finalized , he may advise you to do a few tests for the surgical fitness and meet an anesthetist and a physician.
What to expect before the surgery
Usual pre op investigation done are:
- Physical exam
- ECG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel (blood chemistry profile)
- Viral Markers
- 2D Echo in elderly
Preparation for surgery
MEDICATIONS TO AVOID BEFORE SURGERY
- Aspirin, Warfarin, Clopidogrel and some other blood thinner need to be stopped before elective surgery (5-7 days) after approval from the prescribing physician.
- The patient is kept nill by mouth (NBM) at least 6 hours before the surgery.
The Operation: Laparoscopic nephrectomy / Robotic Nephrectomy is a Keyhole surgery performed through 3-5 small incisions on the abdomen. Various instruments and a telescope are inserted after distending the abdomen by a gas. The kidney is dissected all around the vessels and the ureter is clipped. The final specimen is retrieved after inserting in a plastic bag either extending a port or putting a separate incision (Pfannenstiel)
Open ProcedureLaparoscopic Procedure
- Although this procedure has stood the test of time , like any other surgical procedure, it also carries some risk of complication.
- The usual blood loss is less than 100 cc and need for blood transfusion is seen in less than 5% of patients.
Infection:All the patients are given preop / intra op antibiotics and usually are continued 24-48 hours post-surgery. The risk of the infection is less compared to open surgery, however it may happen.
Tissue / Organ Injury:Although the risk is small if done in experienced hands but in a large tumor or an inflamed kidney there can be injury to the surrounding organs or vasculature requiring open conversion or other intervention.
Hernia :Hernias are quite rare because of the smaller size of incision , but may occur.
Conversion to Open Surgery :Conversion to open surgery is not the failure of the surgeon to do a keyhole surgery but is a wise decision for the safety and better outcome of the patient. It may be needed if there is failure to progress because of dense adhesion to surrounding structure, or bleeding or injury to surrounding viscera.
During your hospitalization
The patient is shifted to the recovery room after surgery, where he is kept for observation for 4-6 hours. If vitals and other parameters are normal, he is usually shifted to his room post-surgery on the same day unless any other comorbidities exist requiring ICU care.
- Postoperative Pain :There may be a transient pain in the shoulder which is due to the carbon dioxide insufflation. The wound is usually infiltrated with local anesthesia during surgery and postoperatively patients receive adjuvant Intravenous analgesics in consultation with the anesthetist.
- Nausea : It may happen because of the medications or the anesthetic drugs.
- Urinary Catheter :Urinary pipe may be present for a couple of days to monitor the urine output. It is usually removed by the second postoperative day.
- Diet :Most of the patients are given clear liquids by evening and a normal diet the next day once he starts tolerating the liquids well.
- Fatigue :Generalized weakness and fatigability can be there because of the anesthetist or other drugs. Usually subsides in 5-7 days.
- Incentive Spirometry : As many patients hold their breathing because of the pain which can result in some lung related complications. Incentive spirometry is advisable to expand the lung and prevent post
- Ambulation :Patient is ambulated on the eve of the surgery. Early mobilization reduces the risk of blood clots in the leg veins , it also speeds up the recovery and bowel movement.
- Hospital Stay :The usual hospital stay is 2-3 days in Laparoscopic / Robotic Nephrectomy
- Constipation / Gas Cramps : The patient can have mild abdominal distention and constipation due to the anesthetic drugs and other medications specially analgesics. Patients are usually given laxative and early mobilization helps in reducing bowel discomfort.
- Pain Control :There may be mild incisional discomfort, and usual oral analgesics are sufficient to care for that.
- Showering :Patients can take a shower 3 days post-surgery, they can wet the surgical site but have to pad it dry immediately after taking the bath.
- Activity :Patient starts walking on the eve of surgery. He can climb stairs after a day. Patients should avoid exercise and gyming for 4-6 weeks. Usually they can resume their normal office work 2-3 weeks after the surgery.
- Diet :it is advisable to take a low salt , low protein diet post kidney removal. Dieticians and nephrologists should be consulted for the proper dietary advice.
- Pathology Results :The pathology report is usually available after 5-7 days of the surgery. Patient needs to review with the surgeon again with the histopathology report.
- Kidney/Liver Function Blood Tests and Xrays :Patients need to have regular follow up as advised by the surgeon.
Robotic Kidney Removal Surgery Chennai
Urocare has the best surgeon for Robotic Kidney Removal Surgery in Chennai. Top Robotic Urologic Surgery for kidney removal treatments or kidney transfer treatment in Chennai. Our Dr. Nitesh jain, he is an leading and experienced surgeon, who has done more urology robotic surgeries successfully in Chennai.