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Laparoscopic Nephrectomy  

Diagram of laparoscopic incision, showing four small spots across the abdomen Laparoscopic procedure.

Laparoscopic Nephrectomy provides patients with a safe and effective way to remove a diseased or cancerous kidney. Laparosopic nephrectomy is a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the larger incision required with traditional open surgery. When compared to conventional open surgery, laparoscopic nephrectomy has resulted in significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes identical to that of open surgery.

The Surgery

Laparoscopic nephrectomy is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 3 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to completely free and dissect the kidney without having to place his hands into the abdomen. The kidney is then placed within a plastic sack and removed intact through an extension of one of the existing incision sites.

Potential Risks and Complications

Diagram of open surgery incision across the abdomen Open procedure.

Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include:

  • Bleeding: Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is needed in less than 5% of patients. If you are interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.

  • Infection: All patients are treated with intravenous antibiotics, prior to starting surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incisions, urinary frequency/discomfort, pain or anything that you may be concerned about) please contact us at once.

  • Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Injury could occur to nerves or muscles related to positioning.

  • Hernia: Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.

  • Conversion to Open Surgery: The surgical procedure may require conversion to the standard open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.

Laparoscopic Partial Nephrectomy

Diagram of laparoscopic incision, showing four small spots across the abdomen Laparoscopic procedure.

Laparoscopic Partial Nephrectomy provides patients with a safe and effective way to remove a small renal tumor, while preserving the remainder of the kidney. This is a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the traditional open surgery.

When compared to the conventional open surgical technique, laparoscopic partial nephrectomy has resulted in significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes that appear to be identical to that of open surgery. Partial nephrectomy has become a standard procedure for select patients with renal cell carcinoma (esp. small < 4cm, peripherally located tumors). The results of partial nephrectomy are less satisfactory in patients with larger renal cell carcinomas, leaving radical nephrectomy (removing the entire kidney) as the standard approach.

The Surgery

Laparoscopic partial nephrectomy is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 4 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to completely free and dissect the tumor without having to place his hands into the abdomen. The defect in the kidney is then sewn closed with sutures and a special sealant glue. The tumor is then placed within a plastic sack and removed intact through an extension of one of the existing incision sites.

Potential Risks and Complications

Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include:

  • Bleeding: Blood loss during this procedure is typically minor and a transfusion is needed in less than 5% of patients. If you are interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.

  • Infection: All patients are treated with intravenous antibiotics, prior to starting surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incisions, urinary frequency/discomfort, pain or anything that you may be concerned about) please contact us at once.

  • Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Scar tissue may also form in the kidney requiring further surgery. Injury could occur to nerves or muscles related to positioning.

  • Hernia: Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.

  • Conversion to Open Surgery: The surgical procedure may require conversion to the standard open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger than standard open incision and possibly a longer recuperation period.

  • Urine Leak: If the urinary collecting system of the kidney needs to be cut across in order to remove the kidney tumor, it is usually sutured closed. If urine leaks out of this hole, you may need to have an internal drainage tube (stent) to help seal the leakage. On rare occasion you may require additional surgery.

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