Laparoscopic nephrectomy

Laparoscopic Nephrectomy is a minimal invasive procedure or ‘key-hole surgery’ to remove a kidney which was traditionally done by the ‘open’ method. It involves the use of a three or four ‘ports’ or cuts about 1cm each which allows access to the organ. A thin tube with a light and a camera on the end and surgical instruments can then be passed through these incisions. The camera send pictures to a screen so that the surgeon can see the kidney and surrounding tissue and remove the kidney this way. One of the incisions is enlarged to enable the kidneys to be removed.

A nephrectomy can be performed for a number of reasons:

1. Chronic infection, which has resulted in scarring and loss of function of the kidney.

2. Kidney stones, which have destroyed most kidney tissue and continues to cause infection.

3. Non-functioning, shrunken or baggy kidneys.

4. To stop uncontrolled bleeding caused by trauma to the kidney.

5. Kidney and/or ureteric tumours.

The kidneys are a pair of organs at the back of the abdomen that filters the blood to remove waste products, which they convert into urine. Each kidney is connected to the bladder by a tube called ureters which carries urine from the kidneys to the bladder. From the bladder the urine passes out of the body through a tube called urethra. The urethra opens immediately in front of the vagina in women and at the tip of the penis in men.

1. Avoids open surgery and large scars. Only small scars from the ports will be visible.
2. Shorter hospital stay.
3. Less pain after the operation.
4. Quicker full recovery.
5. Earlier return to work and normal activities.

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 your surgery.
• 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. Chest infection may occur as a complication of anaesthetic. You can help prevent this by deep breathing.
• Pain: Some patients experience temporary shoulder pain and abdominal bloating for 24hrs after the operation.l 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.

You will attend a pre-assessment clinic to assess your suitability for surgery. Blood tests, urine tests, ECG, MRSA screening will be organised for you. Bring a list of your medications with you. You will also be told what medications to stop and when if you take any.

You may eat and drink as you desire the evening prior to surgery. You will have nothing to eat 6 hours before your operation and water only for 2 hours. You can take medications that have not been stopped.

You will be admitted to the ward on the day and introduced to the nurse who will be looking after you for the day. You will have your blood pressure, pulse, temp checked. You will also be asked to wear anti-thrombus stockings as these prevent clots forming in your legs during surgery.

You will be seen by your operating consultant who will take your consent for the operation. You will also be seen by the anaesthetist. You will then be escorted to theatre by the theatre staff.