What does the procedure involve?
Keyhole surgery to remove part of kidney with its surrounding fat usually for suspected cancer, using a telescope and three to five keyhole incisions; one incision will need to be enlarged to remove the tumour. Robotic assistance aids the surgeon particularly in more complex cases but may not be necessary in straightforward cases.
What are the alternatives to this procedure?
Alternatives to this procedure include observation, removing the whole kidney, and open surgery.
What should I expect before the procedure?
You will usually be admitted to hospital on the same day as your surgery.
You will be asked not to eat and drink for six hours before 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 free the chosen kidney through several keyhole incisions and remove the part that contains the tumour, together with its surrounding fat. This will be put into a bag, which is then removed by enlarging one of the keyhole incisions. The kidney will then be repaired by stitching to prevent bleeding and urine leakage. Robotic-assisted surgery offers quicker and more precise suturing (stitching) compared with standard keyhole surgery particularly in more complex cases. Local anaesthetic is usually injected into each keyhole incision to reduce the level of pain afterwards.
We normally put in a bladder catheter to monitor urine output and a drainage tube through the skin into the bed of the kidney. We may also insert a ureteric catheter up to the kidney through the bladder.
What happens immediately after the procedure?
You will be given drinks at an early stage after the operation and encouraged to mobilise as soon as you are comfortable, to prevent blood clots from forming in your legs. The wound drain will need to remain in place for up to one week in case urine leaks from the cut surface of the kidney.
The average hospital stay is three days.
Are there any side-effects?
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 to 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)
- Need for removal of the ureteric stent (usually under local anaesthetic).
- Temporary pain in the tip of your shoulder.
- Temporary bloating of your tummy.
- Urinary leak from the cut edge of the kidney needing further treatment or insertion of a ureteric stent.
- Bleeding needing blood transfusion or conversion to open surgery.
Occasional (between 1 in 10 and 1 in 50)
- Infection, pain or hernia of the incision needing further treatment.
- Total removal of the kidney may need to be performed if partial removal is not thought to be possible.
Rare (less than 1 in 50)
- 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).
What should I expect when I get home?
You may have some discomfort from the keyhole incisions in your abdomen but this can normally be controlled with simple painkillers. All the wounds are closed with absorbable stitches, which do not require removal.
It will take 10 to 14 days to recover fully from the procedure and most people can return to normal activities after two to four weeks. You cannot play contact sports for 3 months.
If you have a ureteric stent in place, you may notice that you pass urine more frequently and there may be pain in your bladder area.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, you should contact your Surgeon or GP immediately. Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.
Are there any other important points?
If you have had a ureteric stent inserted, we will arrange to remove it six weeks after your 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.