Laparoscopic Radical Nephrectomy
Laparoscopic Radical Nephrectomy is a surgery that helps to remove a large kidney tumor safely. Your doctor may recommend this surgery if your tumor is larger than 4 cm. It involves less blood loss, pain, and a shorter hospital stay when compared with traditional open surgery. The procedure is just as effective in removing kidney tumors as conventional surgery, but it is minimally invasive.
Preparation for Laparoscopic Radical Nephrectomy Surgery
Before your surgery, your surgeon will take a look at your medical history. He will also request some tests for you, which may include a physical exam, complete blood count test (CBC), electrocardiogram (EKG), blood chemistry profile, blood coagulation profile and a urinalysis.
He will also inform you about your diet just before the surgery. You will be prescribed a clear liquid diet the day before the surgery.
Laparoscopic Radical Nephrectomy Procedure
The operation will be carried out under general anesthesia and may take 3 to 4 hours.
During the operation, your surgeon will make three to four small cuts in your abdomen. These are ‘keyhole’ incisions smaller than 1 cm, through which the surgeon will insert a laparoscope and other surgical tools.
A laparoscope is a device that can magnify the operating area by ten times. It is a technology that has eliminated the need for open surgery in many cases.
Your abdomen will be bloated with carbon dioxide so that your surgeon has a larger workspace. The gas will be suctioned out after the operation.
Your surgeon will dissect the kidney that is diseased. He will expose it from the other organs around it, such as the spleen, the liver, and intestines.
Blood supply to the kidney will be limited by clipping some of the blood vessels, to lower blood loss. The surgeon will remove the tumor, kidney, visible lymph nodes and surrounding fat.
Your surgeon may also remove the adrenal gland if the tumor is too large and close to it.
The organs will be placed in a plastic sack, and slowly pulled out from your abdomen through one of the keyholes.
Your surgeon will then sew up the incisions with techniques that will cause minimal scarring.
Risks and Complications
Complications are rare, but potential risks of the operation may include:
- Injury to adjacent organs or tissues
- A hernia at the incisions
An experienced surgeon will reduce the risks and complications of your operation. Sometimes, if the laparoscopic radical nephrectomy is not successful in removing the affected kidney, the operation may be converted to open surgery.
After the Surgery
You will spend some time recovering from your anesthesia in the recovery room. When your vital signs are stable, you will be transferred to your hospital room. Your hospital stay will usually be of 1 to 2 days.
You will slowly advance from liquid to solid diets during your hospital stay. Your surgeon may also place a Foley catheter to drain your bladder until the day after the operation.
You may have to do simple breathing exercises using an incentive spirometry device. These exercises will help to prevent lung infections. You must get out of bed and walk up and down on the evening of the surgery, to prevent blood clots in your legs.
Post-surgery, you may experience the following:
- Mild pain around the incisions, which will be controlled by intravenous or oral pain medication.
- Mild pain in the shoulders, a side effect of the carbon dioxide gas.
- Nausea, due to the general anesthesia.
- Fatigue, which should wane after a few weeks.
- Gas cramps or constipation due to the anesthesia, for a few days after surgery.
Your doctor will tell you about post-operative care at home. In general, you will be advised to walk six times a day in the weeks following the surgery, to prevent deep vein thrombosis or pneumonia. You can shower when you get home, but avoid soaking in a tub for a while, to prevent infection.
You can usually get back to work about three to four weeks after surgery.
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