What is a Laparoscopic Nephrectomy?
Laparoscopic nephrectomy is a “keyhole” operation performed to remove a kidney.
The advantages of laparoscopic nephrectomy over the traditional open nephrectomy (where the kidney is removed through a large incision in the upper abdomen) are:
- Less blood loss.
- Fewer complications.
- Shorter hospital stay.
- Quicker recovery.
- Better cosmetic appearance.
Dr Nathan uses the laparoscopic approach for most patients. However, open nephrectomy may still be indicated for more complex cases or very large tumours.
Why do I need a Nephrectomy?
There are several reasons for removing a kidney:
- The kidney may not be working or only partially working; if left in place it can be a source of infection or pain.
- Infection may have damaged the kidney so that it requires removal.
- A cancer arising in the kidney may have been diagnosed; the usual treatment for this is to remove the kidney.
If a cancer has been found in the kidney, it is sometimes necessary to remove the adrenal gland, which lies on top of the kidney, at the same time.
In some kidney cancers there is a high risk of cancer recurrence in the ureter (tube which carries urine from the kidney to the bladder). If this has been found then the ureter will also have to be removed which would mean a small incision lower down on your abdominal wall as well as the other small incisions.
The reason for removing your kidney will be discussed with you.
What are the alternatives?
Your surgeon will have discussed these alternatives with you, if they apply to your case.
- An open operation
- A partial nephrectomy (removal of part of the kidney)
- No operation
- Surveillance of the kidney
What should I expect before the procedure?
You will usually be admitted to hospital on the same day as your surgery.
Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy. You will need to wear anti-thrombosis stockings during your hospital stay. These help prevent blood clots forming in the veins of your legs during and after surgery.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
- Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.
What happens during the procedure?
A full general anaesthetic is normally used and you will be asleep throughout the procedure. You will usually be given an injection of antibiotics before the procedure, after you have been checked for any allergies. The anaesthetist may also use an epidural or spinal anaesthetic to reduce the level of pain afterwards. The surgeon will use 3-4 small incisions to insert a camera and surgical instruments into the abdominal cavity. The camera sends a magnified image to a TV screen so that the surgeon can see the kidney and surrounding tissue. The surgeon will free the kidney and in cases of suspected cancer the surrounding fat will be left intact over the kidney. The kidney is then put into a bag, which will be removed by enlarging one of the keyhole incisions. A bladder catheter is normally inserted during the operation to monitor urine output and a drainage tube may be placed down to the bed of the kidney.
Potential side effects and complications
All procedures have the potential for side effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure.
Risks of the anaesthetic need be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand.
There are specific risks with this surgical procedure, and these will be discussed with you before your procedure. As a guide to complement that one-on-one discussion with your surgeon, these include:
Common (greater than 1 in 10)
- Temporary pain in the tip of your shoulder.
- Temporary bloating of your tummy.
Occasional (between 1 in 10 and 1 in 50)
- Bleeding, infection, pain or hernia of the incision needing further treatment
Rare (less than 1 in 50)
- Bleeding needing conversion to open surgery or blood transfusion.
- Entry into lung cavity needing insertion of a temporary drain.
- The pathology may turn out not to be cancer.
- Recognised (or unrecognised) injury to organs/blood vessels needing conversion to open surgery (or deferred open surgery).
- Involvement or injury to nearby local structures (blood vessels, spleen, liver, kidney, lung, pancreas, bowel) needing more extensive surgery.
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death). These side effects are not specific to kidney surgery and can occur after any major surgery.
- Dialysis may be needed to stabilise your kidney function if your other kidney functions poorly.
After the operation
You will have intravenous fluids (a drip) going into an arm vein. This will remain in place until you are drinking normally. You can start having some oral fluids immediately after the operation, and the drip can usually be removed the following day. Food can usually be started the day after the operation.
A urinary catheter) will be inserted whilst you are under anaesthetic, which is usually removed the following day. Occasionally during the operation a wound drain is placed at the site of the kidney to drain away any blood. This will be removed when there is little or no drainage from it (usually the following day).
Following the operation, it is usual to have mild shoulder or stomach pain for a couple of days. Most patients only need mild painkillers, but as in any surgery there may be more discomfort requiring stronger painkillers.
You may feel nauseated for 24 hours following the operation but medication can be administered to control this.
You will be encouraged to sit out of bed for 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 walking longer distances.
Once the catheter is removed and you are passing urine satisfactorily and mobilising well, you will be discharged home.
It is sensible to avoid driving for 2-3 weeks and heavy lifting for 6 weeks after the operation. Exercise should be increased gradually. Start with short walks and gentle exercise. Eat a healthy diet with plenty of fluids. Fresh fruit and vegetables are important to keep your bowels regular.
You can return to work when you feel fit and depending on your job. Usually 2-3 weeks off work are needed. Sexual intercourse can be resumed 3-4 weeks after the operation.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.