Laparoscopic Nephrectomy

Overview

A nephrectomy is the surgical removal of a kidney. A partial nephrectomy may be performed by your surgeon to remove only a section of your kidney. Alternatively, you might have a radical nephrectomy, in which the surgeon removes your entire kidney. A nephrectomy can save your life if you have kidney dysfunction or cancer.

In patients with irreversible kidney impairment caused by symptomatic chronic infection, blockage, calculus disease, or severe traumatic injury, a laparoscopic nephrectomy is suggested.

Simple nephrectomy is also used to treat renovascular hypertension caused by irreversible renal artery disease or severe unilateral parenchymal damage caused by nephrosclerosis, pyelonephritis, reflux dysplasia, or congenital kidney dysplasia.

What is Nephrectomy?

The surgical removal of one kidney is known as a nephrectomy. The surgical removal of both kidneys is known as bilateral nephrectomy.

Nephrectomy operations are classified into two types:

A partial nephrectomy is a procedure in which a surgeon removes only the damaged section of the kidney. An open partial nephrectomy or a laparoscopic/robotic partial nephrectomy are also options.

A radical nephrectomy is a surgical procedure in which the entire kidney is removed. Surgeons may also remove a piece of the ureter (the tube that connects the bladder to the kidneys) in a technique known as nephroureterectomy. They could also take off the adrenal glands (hormone glands that sit above the kidneys). This surgery can also be done open, laparoscopically, or robotically.

Indications

A nephrectomy is often performed for one of two reasons: kidney cancer or a non-functioning kidney:

A radical laparoscopic nephrectomy is performed in the case of kidney cancer. This is done in an attempt to cure cancer by removing the whole kidney and adrenal gland, together with the surrounding fat and associated veins. It may be done in more severe situations to halt further bleeding from the affected kidney.
A simple laparoscopic nephrectomy is performed on non-functioning kidneys caused by big renal stones, a lack of blood flow, or abnormal kidney anatomy. Only the kidney is removed, leaving the adrenal gland and other components behind. A simple nephrectomy is frequently performed to minimize recurring infection and discomfort, as well as the chance of serious sickness due to infection.

Difference Between Laparoscopic & Open Surgery

Nephrectomies are performed using two distinct procedures by surgeons. A small instrument with a camera (laparoscope) and a few tiny incisions are used in a laparoscopic nephrectomy. A surgical robot is operated by the surgeon in a robotic-assisted laparoscopic case to manage these microscopic instruments. An open nephrectomy is performed by a single big incision. Surgeons do not utilize cameras and instead see directly into the body.

Shorter hospital stays and quicker recovery periods may result from laparoscopic nephrectomy. If laparoscopic surgery is not an option, physicians may turn to open surgery. Laparoscopic surgery, for example, frequently necessitates longer periods of anesthesia. Some people may not respond well to long periods of anesthesia. Others may have a big kidney tumor for which these minimally invasive techniques are not appropriate. In these cases, an open approach could be safer.

The Surgical Procedure

Anesthesia:

You will be prohibited from eating or drinking anything for at least six hours before to your procedure. Chewing gum and sweets are examples of this.

You will be given general anesthesia and will be sleeping during the procedure, remembering nothing of it. Feel free to speak with your anesthesiologist about the anesthesia and any questions you may have.

Consent:

We need your permission to proceed with your surgery. It is critical that you understand the risks and side effects of the surgery and anaesthesia before signing the consent form. Your doctor and nurse will go through this with you, and if you have any questions, your nurse or doctor will gladly answer them.

If you want your kidney returned to you for personal reasons, please talk to your family about it and notify your nurse and surgeon before the procedure.

The procedure:

The kidney is removed using laparoscopic instruments during laparoscopic nephrectomy. Long, thin tools are passed into up to five tiny, 1cm-long incisions in the flank. The abdomen is initially inflated with carbon dioxide, which separates the tissues and allows for visibility throughout the procedure. The urologist is then shown a detailed image of the abdomen through a camera. Other incisions are used to insert cutting and suturing equipment, allowing the blood supply to the kidney to be separated and closed off, and the kidney to be removed with or without its surrounding tissues. After that, a wound drain is installed to remove any wound oozing. This is often stitched in place and remains in place for 1–2 days.

When the procedure is completed, the carbon dioxide air is extracted from the abdomen and the wounds are repaired with dissolving stitches. Small plasters are then applied to the affected regions. To monitor the urine production from the remaining kidney, a catheter (a drainage tube that drains urine from the bladder) is also implanted. The catheter is normally left in place for 1–2 days, or until you are able to move around.

Laparoscopic Nephrectomy takes between 2 - 4 hours to complete and requires a 1 – 2-night hospital stay.

There is a danger of infection and blood loss with any procedure. The kidneys have a significant blood supply, and operation always involves some bleeding.

Antibiotics are frequently used during surgery to avoid infection. A blood transfusion may be required to compensate for blood loss after surgery in a limited percentage of patients. If you require a blood transfusion and choose to decline one, you must notify your surgeon and nurse prior to the procedure. Prior to surgery, you may be able to donate some of your own blood. If you want to do this, please consult with your surgeon.

There is always the chance that the surgeon may need to do open surgery, which requires a single, bigger incision in the flank. This occurs seldom and might be the result of device failure, significant bleeding, or other challenges faced.

After Surgery

Your blood pressure and pulse will be checked on a regular basis by your nurse. Your wound and the discharge from it will also be properly examined.

A drip will be placed in your arm to ensure that you receive appropriate fluids. This will be erased once you resume normal drinking. You can normally drink after surgery and eat after you are able to tolerate fluids.

Urine will drain from your bladder into a bag via the catheter. Your urine production will be measured every hour by your nurse. The urine will most certainly be blood colored, although this will normally resolve within the first 24 hours. A tiny, inflated balloon holds the catheter inside your bladder, preventing it from leaking out.

A drip will be placed in your arm to ensure that you receive appropriate fluids. This will be removed after you are able to drink normally and your post-operative antibiotic therapy is finished. When you return to the ward, you can normally drink and eat if you can tolerate fluids. Typically, this is a very well-tolerated operation with minimal pain, and our goal is to keep you comfortable, so please notify your nurse if you suffer any pain or discomfort so that you may receive the proper care. Your nurse is always available to assist you; please ring your bell if you want assistance and your nurse is not around.

You will be able to be up and about as able but may need assistance the first time you get up out of bed. You should do regular deep breathing and leg exercises after surgery until you are fully mobile. The physiotherapist may come and see you to give further instructions.

When you return home, you will be issued a discharge letter with useful instructions on how to care for yourself. We will send you an outpatient appointment for a follow-up with the expert 4-6 weeks following your procedure, and we will also send a note to your own doctor detailing your operation and the specifics of your treatment while you were in the hospital.

Home Precautions

Activity:

Sleep when you're tired. Getting adequate sleep can assist you in recovering.
Make an effort to walk every day. Begin by walking a bit more than you did the previous day. Increase your walking distance gradually. Walking increases blood flow and aids in the prevention of pneumonia and constipation.
Avoid abdominal workouts and intense activity like biking, running, weight lifting, or aerobic exercise until your doctor says it's acceptable.
Avoid lifting anything that will cause you to strain for at least 4 weeks. A child, heavy shopping bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner are all examples.
Hold a pillow over the cuts the doctor made (incisions) when you cough or take deep breaths. This will support your belly and decrease your pain.
At home, perform breathing exercises as directed by your doctor. This will aid in the prevention of pneumonia.
Inquire with your doctor about when you will be able to drive again.
You would most likely need to take 4 to 6 weeks off work. It depends on the nature of your employment and how you feel.
You might be able to shower (unless you have a drainage tube near your incisions). If you have a drainage tube, empty it and care for it according to your doctor's recommendations. Do not shower for the first two weeks, or until your doctor says it is safe.
Ask your doctor when it is okay for you to have sex.

Diet:

You can continue to eat your regular diet. If you were on a renal diet before surgery, stick to it until your doctor instructs you to quit.
If you have a stomach ache, eat bland, low-fat items such as plain rice, broiled chicken, toast, and yogurt.
Drink plenty of water (unless your doctor tells you not to).
You may notice that your bowel motions are irregular immediately following surgery. This is rather frequent. Constipation and bowel straining should be avoided. You should consider taking a fiber supplement every day. If you haven't had a bowel movement in a few days, consult your doctor about using a mild laxative.

Medicines:

Your doctor will inform you when and if you may resume taking your medications. He or she will also teach you on how to take any new medications.
If you use aspirin or another blood thinner, see your doctor about when and if you should resume taking it. Make sure you understand everything your doctor wants you to do.

Take pain medicines exactly as directed:

If the doctor gave you a prescription medicine for pain, take it as prescribed.
If you are not taking a prescription pain medicine, take an over-the-counter medicine that your doctor recommends. Read and follow all instructions on the label.
Do not take aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve), or other non-steroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.

If you think your pain medicine is making you sick to your stomach:

Take your medicine after meals (unless your doctor has told you not to).
Ask your doctor for a different pain medicine.
If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care:

If you have tape strips on the incisions, leave them on for a week or until they come off.
Wash and pat dry the area surrounding the incisions with warm, soapy water on a regular basis. Avoid using hydrogen peroxide or alcohol, both of which can impede recovery. If the wounds are weeping or rubbing against clothes, wrap them with gauze bandages. Every day, change the bandages.
Maintain a clean and dry area around the incisions.

Risks & Complications

Nephrectomy is a relatively safe operation. However, like with any operation, there is a chance of complications, such as:

Bleeding.
Infection.
Damage to neighboring organs.
Other significant issues are uncommon.

Long-term effects from a nephrectomy are related to the possible difficulties of living with less than two complete, fully functioning kidneys. Although total kidney function declines following a nephrectomy, the residual kidney tissue normally functions adequately for a healthy life.

Long-term kidney function problems may include:

high blood pressure (hypertension)
chronic renal disease

When to Call Your Doctor?

Contact your doctor if:

any of your wounds become red, hot, swollen, painful, or continue to discharge.
If your urine becomes dark or foul smelling, or if you exhibit any other symptoms of a urinary infection, consult your doctor.
If you even have any concerns

The most essential thing to remember is that you are not alone. Many people, including yourself, have had successful laparoscopic nephrectomy. Humans can readily survive with one kidney, and there is no reason why you should not be able to function normally after surgery. Everything will be easier if you have a good mindset. There is every reason to expect that you will be successful.

Care of the Remaining Kidney

Regular tests will be performed to see how well the remaining kidney is functioning. Every year, a urinalysis (urine test) and blood pressure should be performed, and kidney function tests (creatinine, glomerular filtration rate [GFR]) should be performed every few years (or more often if abnormal results are found). Protein urine tests should also be performed on a regular basis. Protein in the urine may indicate that the kidney has been harmed.

People who only have one kidney should avoid sports that require intense contact or collision. Boxing, field hockey, football, ice hockey, lacrosse, martial arts, rodeo, soccer, and wrestling are examples. This might involve extreme sports like skydiving. Anyone with a single kidney who wishes to engage in these activities should use extreme caution and wear protective padding. He or she should realize that losing the remaining kidney is a serious situation.

Conclusion

A nephrectomy is the surgical removal of a kidney. The procedure is most commonly used to treat kidney cancer or to remove a noncancerous (benign) tumor. A nephrectomy is sometimes performed to treat a diseased or severely damaged kidney. A donor nephrectomy occurs when a urologic surgeon takes a healthy kidney from a donor for transplant into a person who need a working kidney.

A nephrectomy can be performed with a single incision in the abdomen or side (open nephrectomy) or through a series of tiny incisions in the abdomen using a camera and small equipment (keyhole nephrectomy) (laparoscopic nephrectomy).

In certain situations, these laparoscopic operations are carried out with the assistance of a robotic system. The surgeon performs robotic surgery while sitting at a computer console beside the operating table. He or she is in charge of the camera arm and mechanical arms, which are coupled to surgical tools that are functioning within the patient's body.

Potential risks and consequences are determined by the type of operation, the reason for the surgery, the patient's overall health, and a variety of other factors, including surgeon competence and experience.