Laparoscopic Nephrectomy- keyhole surgery

Laparoscopic Nephrectomy

The aim of a laparoscopic nephrectomy is to remove a kidney using a keyhole surgical technique. There are several reasons why you may need a kidney to be removed. The majority of cases are due to cancer, however other reasons include; a kidney may only be partially working, or not working at all or due to kidney damage from an infection that requires its removal. Your consultant will discuss the reasons with you why it may be necessary to remove one of your kidneys.

Before the procedure

You will have a pre-assessment with your consultant prior to surgery. Your consultant will explain the procedure, the risks and benefits, and answer any questions you might have. You may need to have various scans and blood tests so that the surgeon has as much information as possible. These tests will also make sure that your remaining kidney is functioning normally.

The Procedure

The procedure is normally carried out under general anaesthetic which means you will be asleep throughout the surgery and will not feel any pain.

The surgeon will make 3-4 small incisions in your abdomen. A surgical balloon is inserted through a port and inflated to create a space in the back compartment of the abdomen where the kidney sits. The balloon is then removed and carbon dioxide gas is used to fill the space.

A thin tube with a light and camera on the end (a laparoscope), and surgical instruments can then be passed through the incisions. The camera sends pictures to a TV screen so that the surgeon can see the kidney and surrounding tissue. One of the incisions will be enlarged to enable the kidney to pass through once it has been disconnected from the surrounding tissues and blood vessels. In some cases, the adrenal gland which is situated at the top of the kidney, may also be removed.

The operation usually takes 2-3 hours but can vary depending on the individual.

After the procedure

Following the operation, it is usual to have mild shoulder or stomach pain for a couple of days. This pain is often described as a “wind-like” pain and is due to the surgeon using gas to inflate your abdominal cavity so that he can see the kidney better. After the first twenty-four hours, most patients only need mild painkillers, but as in any surgery, there may be more discomfort requiring stronger painkillers.

A catheter (tube) to drain urine from the bladder will be inserted whilst you are under anaesthetic. This allows accurate measurements of your urine output. The urine may be blood-stained, but this is normal and will clear the following day. The catheter is usually removed the following day.

You will be encouraged to sit out of bed for short periods the day following the operation and to walk a short distance. On the second day after the operation, you should be able to be out of bed most of the day and walk longer distances.

Once the catheter is removed and you are passing urine satisfactorily and mobilising well, you will be discharged home.

It may take up to 12 weeks to fully recover from your operation, but most people can return to normal activities by 4 weeks. During this recovery time, you should not perform any heavy lifting or strenuous activities (such as shopping, vacuuming, mowing the lawn) as this may slow your recovery time and delay wound healing. However, you are encouraged to remain active to reduce the risk of DVT.

It is recommended that you avoid driving for 3 weeks after your operation, and should not return to driving until you can perform an emergency stop without feeling hesitant.

We also suggest that you take 2 to 4 weeks off work, but if your job involves heavy lifting or strenuous activity please talk to a consultant as you may require more time off.

Risks and benefits of laparoscopic surgery

The advantages of this surgery include;

  • Reduced blood loss with a reduced chance of requiring a blood transfusion.

  • Reduced pain after the operation: There is no large abdominal wound, so patients can normally return to normal activities more quickly after keyhole surgery

  • A shorter stay in hospital: Most patients normally go home after 2 to 3 nights, compared to 5 to 6 nights after open surgery

  • Smaller scars: Keyhole surgery avoids a large scar, but the small scars will still be visible

  • Quicker return to normal activity: usually 3 to 4 weeks after keyhole surgery as compared with 6 to 8 weeks after open surgery.

All surgery carries an element of risk. The specific risks and potential side-effects of this surgery include;

  • Problems related to the general anaesthetic including chest infection, deep vein thrombosis (DVT), pulmonary embolus, heart attack and stroke.

  • Bleeding. The kidney has a very good blood supply, therefore, major bleeding is a risk and you may require a blood transfusion

  • Infection. Any breach of the skin carries a risk of infection, but antibiotics are given to help reduce the risk of this.

  • Conversion to open operation. If there is a lot of bleeding, injury to other structures (for example, bowel or blood vessels) or the surgeon experiences problems, your surgeon may decide it is safer to change to an open nephrectomy to remove your kidney, although this is very rare.

  • Delayed wound problems.

  • Injury to other structures. The structures more likely to be damaged include the bowel, spleen, liver, pancreas, diaphragm and the nerves of the abdominal wall muscles.

  • Damage to lung cavity. Requiring the temporary insertion of a chest drainage tube

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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