What is a laparoscopic nephrectomy?
A laparoscopic nephrectomy is a minimally invasive procedure for removing a kidney. It is particuarly suitable for patients with benign conditions that have resulted in end-stage renal failure including infection, stones, obstruction, dysplasia and renal vascular hypertension. It is also an excellent treatment of localized renal tumours measuring up to 12 - 15 centimeters in size.
Unlike a conventional open nephrectomy, laparoscopic surgery requires only three or four small incisions. Through these incisions the surgeon uses a telescope/camera and specialized instruments to conduct the operation. It usually takes 2 hours and only requires an overnight stay in hospital.
What are the advantages?
• Avoidance of bowel complications (particularly if performed in the retroperitoneum)
• Reduced hospital stay (one day in young healthy patients) and faster healing
• Less postoperative pain and hence less need for pain killers (and there side effects)
• Quicker return to normal activities and work
• Smaller incisions, less scarring and good cosmesis
What will happen?
You will be admitted on the day of surgery; fasted for six hours. You will be administered an enema on the ward to empty your bowel. The operation is carried out under general anaesthetic. You will be catheterised during the surgery. 3-4 small holes are made in your tummy wall. A telescope is inserted into the abdomninal cavity and the abdomen filled with gas. Using long telescopic instruments the kidney is mobilised, the blood vessels are clipped and divided before placing the kidney in a bag and removed. When performed for cancer this will be by a small (2 inch) cut in the lower abdomen. If the operation is for benign disease, we usually remove the kidney in small pieces through one of the telescope entry sites. The small wounds are closed with dissolving stitches and a drainage tube may or may not be left at the site of where the kidney was removed. It is usual to have mild discomfort and most patients only require simple painkillers.
Despite the absence of a large cut this is still a major operation. There is a risk of bleeding requiring a blood transfusion (5%). urinary and chest infections. Rarely, bowel injury or obstruction may necessitate revision surgery. Whilst we have had no deaths after this operation there is a small risk of serious complications eg., venous thrombosis or cardiac problems.
After any surgery you may feel tired and a little bit emotional. This is quite normal, but if you feel depressed it is important to let someone ie your GP know. It is sensible to avoid heavy lifting and driving for 2-3 weeks. Return to work when you feel fit. We will review y6ou in clinic in 4-6 weeks time. Further follow-up will be dictated by the original problem.
Traditional Open Nephrectomy
One 30cm oblique wound
Two 12mm wounds (red) and one 0.5cm wound (blue)