Laparoscopic Nephrectomy

Overview

Laparoscopic Nephrectomy provides patients with a safe and effective way to remove a diseased or cancerous kidney. Laparosopic nephrectomy is a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the larger incision required with traditional open surgery. When compared to conventional open surgery, laparoscopic nephrectomy has resulted in 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.

PRIOR TO THE SURGERY

What to expect during your preoperative consultation

During your initial consultation with your surgeon, he will review your medical history as well as any outside reports, records, and outside Xray films (e.g. CT scan, MRI, sonogram). A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for surgery, you will then meet with a Patient Service Surgery Coordinator to arrange for the date of your operation.

NOTE: It is very important that you gather and bring all of your Xray films and reports to your initial consultation with your surgeon.

What to expect prior to the surgery

Following pre-operative testing done prior to your surgery.

Physical exam
EKG (electrocardiogram)
CBC (complete blood count)
PT / PTT (blood coagulation profile)
Comprehensive Metabolic Panel (blood chemistry profile)
Urinalysis

Preparation for surgery

Medications to Avoid Prior to Surgery

Aspirin, Warfarin, Clopidogrel and some other arthritis medications can cause bleeding and should be avoided 1 week prior to the date of surgery . Do not stop any medication without contacting the prescribing doctor to get their approval).

Bowel Preparation and Clear Liquid Diet

Do not eat or drink anything after midnight the night before the surgery and drink one bottle of Magnesium Citrate (can be purchased at your local pharmacy) the evening before your surgery.

Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through.

THE SURGERY

The Operation

Laparoscopic nephrectomy is performed under a general anesthetic. The typical length of the operation is 2-3 hours. The surgery is performed through 3-4 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to completely free and dissect the kidney without having to place his hands into the abdomen.The kidney is then placed within a plastic sack and removed intact through an extension of one of the existing incision sites.

Open Procedure

Laparoscopic Procedure

Potential Risks and Complications

Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include:

Bleeding : Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is needed in less than 5% of patients.
Infection : All patients are treated with intravenous antibiotics, prior to starting surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incisions, urinary frequency/discomfort, pain or anything that you may be concerned about) please contact us at once.
Tissue / Organ Injury : Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Injury could occur to nerves or muscles related to positioning.
Hernia : Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.
Conversion to Open Surgery : The surgical procedure may require conversion to the standard open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.

What to Expect After Surgery

During your hospitalization

Immediately after the surgery you will be taken to the recovery room, then transferred to your hospital room once you are fully awake and your vital signs are stable

Postoperative Pain : Pain medication can be controlled and delivered by the patient via an epidural or an intravenous catheter or by injection (pain shot) administered by the nursing staff. You may experience some minor transient shoulder pain (1-2 days) related to the carbon dioxide gas used to inflate your abdomen during the laparoscopic surgery.
Nausea : You may experience some nausea related to the anesthesia. Medication is available to treat persistent nausea.
Urinary Catheter : You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while the patient is asleep) for approximately one day after the surgery. It is not uncommon to have blood-tinged urine for a few days after your surgery.
Diet : You can expect to have an intravenous catheter (IV) in for 1-2 days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated; in addition it provides a way to receive medication.) Most patients are able to tolerate ice chips and small sips of liquids the day of the surgery and regular food the next day. Once on a regular diet, pain medication will be taken by mouth instead of by IV or shot.
Fatigue : Fatigue is common and should start to subside in a few weeks following surgery.
Incentive Spirometry : You will be expected to do some very simple breathing exercises to help prevent respiratory infections through using an incentive spirometry device (these exercises will be explained to you by the nursing staff during your hospital stay). Coughing and deep breathing is an important part of your recuperation and helps prevent pneumonia and other pulmonary complications.
Ambulation : On the day of surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can also expect to have SCD’s (sequential compression devices) along with tight white stockings to prevent blood clots from forming in your legs.
Hospital Stay : The length of hospital stay for most patients is approximately 2 days.
Constipation / Gas Cramps : You may experience sluggish bowels for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of mineral oil daily at home will also help to prevent constipation. Narcotic pain medication can also cause constipation and therefore patients are encouraged to discontinue any narcotic pain medication as soon after surgery as tolerated.
Pain Control : You can expect to have some incisional discomfort that may require pain medication for a few days after discharge, and then 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.
Activity : Taking walks is 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 1- 2 weeks after surgery. Absolutely no heavy lifting or exercising (jogging, swimming, treadmill, biking) for six weeks or until instructed by your doctor. Most patients return to full activity at home on an average of 3 weeks after surgery. You can expect to return to work in approximately 4 weeks.
Diet : You should be on a no added salt diet and always avoid high protein diets as both can cause potential damage to your remaining kidney. It is best to discuss methods and guidelines to protect your remaining kidney with your primary care physician after fully recovering from surgery.
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 followup appointment in the office.

Kidney/Liver Function Blood Tests and Xrays : Patients are encouraged to have an annual blood test to include a serum creatinine (to follow the function of the remaining kidney) and liver function tests, performed by their primary care physician. Your surgeon will also review these results in the office during follow up visits. In patients with kidney tumors, follow up Xray tests (e.g. CT, MRI, sonograms) may be periodically required to follow the appearance of your remaining kidney.