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Laparoscopic partial nephrectomy (partial removal of the kidney)
A. This involves removal of part of the kidney with the surrounding fat for suspected cancer of the kidney, through several keyhole incisions. It involves the placement of a telescope and operating instruments into your abdominal cavity using three to five small incisions. One incision will need to be enlarged to remove the tumor.
A. The alternatives to this procedure are:
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 urologist in advance of your surgery if you have any of the following:
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. One incision will need to be enlarged to remove the kidney.
A bladder catheter is normally inserted and kept post operatively, to monitor urine output, and a drainage tube is usually placed through the skin to sit beside the cut kidney surface. Occasionally, a small tube (or stent) is placed internally from the collecting system of the kidney to the bladder to help with healing. If placed, this will need to be removed by a second procedure, usually performed telescopically via the bladder, a few weeks after surgery.
Occasionally, it may be necessary to insert a stomach tube through your nose to prevent distension of your stomach and bowel with air.
A. You will be given fluids to drink from an early stage after the operation and you will start a light diet within one to two days. You will be encouraged to mobilise early to prevent blood clots in the veins of your legs.
The wound drain will need to stay in place for a few days in case urine leaks from the cut kidney surface. In some patients, the drain needs to stay in place longer and you will then go home with the drain and catheter still in place to allow the kidney to heal fully.
A. We would expect your hospital stay to be three to four days but some patients go home sooner.
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.
Common (greater than one in 10)
Occasional (between one in 10 and one in 50)
Rare (less than one in 50)
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 10 to 14 days to recover fully from the procedure and most people can return to normal activities after two to six weeks.
Many patients have persistent twinges of discomfort in the loin 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.
If a ureteric stent has been inserted, you may notice that you pass urine more frequently with pain in the bladder region or at the tip of the penis after passing urine.
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.
If a cancerous growth is found in the removed kidney, you will be closely followed in clinic with blood tests every six months, and chest X rays and scans less frequently.
After removal of tumor, there is no need for any dietary or fluid restrictions since your remaining kidney can handle fluids and waste products with no difficulty.
If a ureteric stent has been inserted, arrangements will be made for its removal approximately six weeks after discharge from hospital. Some patients who have a ureteric stent inserted need to go home with their catheter still in place to allow the kidney to heal completely.