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Laparoscopic Radical Nephro-ureterectomy (Radical removal of the kidney, ureter and bladder cuff)
A. This involves removal of the kidney (and surrounding fat) for suspected cancer of the kidney and/or the ureter through several keyhole incisions. It requires the placement of a telescope and operating instruments into your abdominal cavity using four to five small incisions. The whole ureter along with cuff of bladder is removed either using a telescope or with a separate incision in the lower abdomen.
A. The alternatives include:
A. Laparoscopy (otherwise known as “keyhole surgery”) is a form of minimal access surgery. This involves performing operations which are traditionally done by an “open” method but using “keyholes” instead. A number of urological procedures are now being performed by this
method. It has been shown to be safe and effective for kidney surgery; for the removal of a kidney it is now the method of choice.
Your urologist will discuss the details of the procedure with you whilst you are an outpatient, outlining the procedure as part of your consent. You should be aware that there is a small chance (less than 1%) that your procedure may need to be converted to an open procedure. For this reason, if you are insistent that you would not agree to an open operation under any circumstances, we would not be able to proceed with the laparoscopic operation.
A. You will usually be admitted a day before your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team including the consultant, junior urology doctors and nurse.
You must prepare yourself to mobilise immediately after the operation. You should try to walk at least 10 lengths of the ward before your operation. You will be asked not to eat for six hours before surgery.
Before your procedure, the anaesthetic team will visit you to ensure that they have no concerns about anaesthetizing you. You are encouraged to ask them questions at this stage about any concerns or issues you have concerning the anaesthetic.
You will need to have a small enema in the morning prior to surgery. Once your bowels have been opened, you can have a shower and prepare yourself in a clean gown.
Please be sure to inform your uroCo-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
A. Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post operatively.
You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
The kidney is usually accessed through multiple key hole-incisions in your abdomen. It involves the placement of a telescope and operating instruments into your abdominal cavity using three to five small incisions.
You may require a second incision in the lower part of the abdomen to detach the ureter form the bladder; sometimes, this detachment can be performed using a telescope passed into the water pipe (urethra).
A bladder catheter is inserted at the time of the operation to monitor urine output, and a drainage tube is usually placed through the skin into the bed of the kidney.
Occasionally, it may be necessary to insert a stomach tube through your nose, if the operation was particularly difficult, to prevent distension of your stomach and bowel with air.
A. After the operation, you may remain in the special recovery area of the operating theatres before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will normally have a drip in your arm and, occasionally, a further drip into a larger vein in your neck.
You will be able to drink clear fluids immediately after your operation and start a light diet within one to three days. We will encourage you to mobilise as early as possible and to take fluids or food as soon as you are able.
The wound drain will need to remain in place for 48 hours in case urine leaks from the bladder. The catheter will need to remain in place for up to 14 days after surgery to keep your bladder empty and give it a chance to heal. You will go home with the catheter in place and will be taught how to take care of it before you go home.
A. We would expect your hospital stay to be about three to five days but some people do go home sooner or may need to stay slightly longer.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
A. Before you leave hospital, the team will ensure you are safe to be discharged home. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
When you are discharged from the ward, you will need some comfortable, loose clothing as you may find that your abdomen is uncomfortable and swollen.
You will need someone at home with you for the first few days after you are discharged. A two to four-week convalescence period is usually necessary after surgery. During this time, it is not unusual to feel weak and tired.
There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers. It will be at least 14 days before healing of the skin wound occurs but it may take up to six weeks before you feel fully recovered from the surgery. You may return to work when you are comfortable enough and your urologist is satisfied with your progress. It will take 14 to 21 days to recover fully from the procedure and most people can return to normal activities after four to six weeks.
Many patients have persistent twinges of discomfort in the loin wound which can go on for several months. It is usual for there to be bulging of the wound when an incision in the loin is used, due to the nerves supplying the abdominal muscles being weakened.
You will have a catheter present when you go home.
A. If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your urologist.
Any other post-operative problems should also be reported to your urologist, especially if they involve chest symptoms.
A. It will be at least 10 to 14 days before the pathology results on your kidney are available. An outpatient appointment will be made for you within first week of discharge, followed by two weeks after the operation when we will be able to inform you of the pathology results and give you a plan for follow up.
Once the results have been discussed, it may be necessary for further treatment but this will be discussed with you by your urologist.
You will usually need to undergo regular bladder inspections to check that the growth that involved your kidney is not affecting the bladder lining.
After removal of one kidney, there is no need for any dietary or fluid restrictions since your remaining kidney can handle fluids and waste products with no difficulty.