Laparoscopic Kidney Removal (Nephrectomy)

WHAT IS THE KIDNEY?

The two kidneys filter the blood. They take out waste products and balance fluids, producing urine as a result. They also help to keep blood pressure within normal limits.  They are located in the back of the abdomen.  You can live with only one kidney, however, it is important to continue with any recommended checks, for example X-rays for stones or blood pressure measurements.

HOW DO I KNOW IF MY KIDNEY SHOULD BE REMOVED?

A kidney may need to be removed for a number of reasons.  These are outlined below:

• The kidney may be only partially working, or not working at all.  If left in place it can be a source of repeated infections and pain.
• Infection may have damaged the kidney so that it requires removal.

• The kidney may not be working and may be causing high blood pressure.

• The kidney may be removed for transplantation.

• A cancer arising within the kidney may have been diagnosed.  The usual treatment for this is to remove the affected kidney.

• If a cancer has been found in the kidney, it is occasionally necessary to remove the adrenal gland, which lies on top of the kidney, at the same time.

• For some kidney cancers, there is a high risk of cancer recurrence in the ureter (the tube which carries urine from the kidney to the bladder).  If this type of cancer has been found, you will need a small incision low down on your abdominal wall, as well as the kidney operation described.

The reason for removing your kidney will be discussed with you.  Before the operation is carried out it is usual to perform various scans and blood tests so that the surgeon has as much information about the diseased or cancerous kidney as possible.  These tests also make sure that the remaining kidney is working normally.  Providing that the remaining kidney is functioning normally you will not need to make any change to your lifestyle (eg diet) or activities after the operation.

HOW ARE THESE PROBLEMS FOUND?

Usually patients have had symptoms of kidney problems or high blood pressure.  Masses in the kidney are often found on scans.

WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC NEPHRECTOMY?

Results may vary depending on your overall condition and health. Usual advantages are:

• Less postoperative pain
• Shorter hospital stay
• Faster return to a regular, solid food diet
• Quicker return to normal activities
• Better cosmetic results

AM I A CANDIDATE FOR LAPAROSCOPIC KIDNEY REMOVAL?

Most patients can have a laparoscopic nephrectomy. You should obtain a thorough evaluation by a surgeon at University Surgeons Associates along with consultation with your other physicians to find out if this technique is appropriate for you.

WHAT PREPARATION IS REQUIRED?

• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• Blood transfusion and/or blood products such as platelets may be needed depending on your condition.
• Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery.
• It is recommended that you shower with antibacterial soap the night before or morning of the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon and/or anesthesiologist has told you to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.

HOW IS LAPAROSCOPIC REMOVAL OF THE KIDNEY DONE?

You will be placed under general anesthesia and be completely asleep. A cannula (hollow tube) is placed into the abdomen by your surgeon and your abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which projects a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on your abdomen to allow your surgeon to place instruments inside your belly to work and remove your kidney.  Sometimes a handport is placed through a larger incision to allow the surgeon to use a hand to assist with the surgery. After the kidney is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions on your abdomen. The kidney is broken up into small pieces (morcelated) within the special bag and completely removed.  If the kidney needs to be removed intact then the incision is enlarged or it is removed through the handport site.

WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the open procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

WHAT CAN I EXPECT AFTER SURGERY?

After surgery you will be given intravenous fluids (IV’s) in your arm. You will be given pain medication to relieve the discomfort you may experience from the small incisions. You will need to let your nurse and surgeon know what your pain medication needs are since everyone has a different pain threshold.

As soon as you can resume oral intake, urinate, and care for your basic needs, you will typically be able to go home. Your surgeon will tell you when it is safe to go home.

AT HOME...

Typically, once you have gone home, you may do the following, but each situation differs and at home activities should be discussed with your doctor.

• Activity: You can walk and go up stairs. You can shower, but most surgeons prefer that you do not soak in a tub for at least a week or more after surgery. When you feel stronger ask your surgeon about more strenuous activities.
• Driving: Ask your surgeon. Most people can resume driving 5 to 7 days after surgery. You should not be taking pain medication when you drive.
• Diet: Unless you have special dietary needs, such as diabetes, you can eat a normal diet at home.
• Bowel function: It is common to get constipated after surgery, especially when you are taking pain medication. It is important to drink plenty of water and take in enough fiber in your diet. Your surgeon may advise you about means to help your bowel function postoperatively. Ask or call your surgeon before taking a cathartic.

WHAT COMPLICATIONS CAN OCCUR?

Complications following laparoscopic nephrectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case. Possible complications may include cannula site infections, pneumonia, internal bleeding or infection inside the abdomen at the site where the kidney used to be, although these complications are infrequent.  Problems that can occur a few months to years later are hernias at the cannula or handport sites.

WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following:

• Persistent fever over 101 degrees F (39 C)
• Bleeding
• Increasing abdominal swelling
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Purulent drainage (pus) from any incision
• Redness surrounding any of your incisions that is worsening or getting bigger
• You are unable to eat or drink liquids