Laparoscopic (Radical) Nephrectomy

For renal cancers contained in the kidney. This is a intended curative procedure, depending on staging.

Also for symptomatic, non-functional kidneys. Least invasive procedure with quick recovery.

Why is it done?

• Incidental finding of a solid renal mass larger than 3cm suspicious of a renal cancer.
• A symptomatic non-functioning kidney.
• Usually asymptomatic.
• Late symptoms include:
  • Hematuria.
  • Palpable Mass.
  • Flank pain.
• Curative process for Renal Cell Carcinoma.
• Staging should be negative ie. No spread of tumour.
• Staging with:
  • CT abdomen and chest.
  • Bonescan.
  • MRI if in Renal Failure or Contrast.
  • Allergy.
• Risk for post-operative dialysis will have been discussed prior to your surgery by means a referral; to a Nephrologist.

Very Important!

The correct side for surgery should be checked:

• CT scan present.
• Your approval.
• Prior to anaesthesia being.
• commennced.

How is it done?

• • Patients will receive a general anaesthesia, unless contra-indicated.
  • Prophylactic anti-biotics is given.
  • An indwelling catheter is placed.
  • The correct kidney is identified and marked while you are a.
  • Depending on the side of the tumour 3-4 incisions will be made: 1 for the hand-port of approximately 8cm depending on the amount of sub-cutaneous fat present 1 for the camera-port 1 for the working-port (1 for the liver retractor on the right)
  • The colon is reflected to reveal the retro-peritoneal space
  • The ureter is identified and cleared up to the hilum

• The arteries are identified and tied off and cut first. More than 1 can be present
• Then the vein/ viens are tied and cut.
• The rest of the kidney is mobilized with its surrounding fat and removed.
• The adrenal gland is also removed in large tumours and upper pole tumours.
• Lymphnodes surrounding the blood supply to the kidney will be removed if the tumour is larger than 4 cm.

What next?

• You will spend up to 3-5 nights in hospital.
• You will have a catheter for that time.
• A drain for 2-3 days.
• You will a trial without the catheter on the 3rd day.
• Renal functions will be checked daily.
• You may enter a phase of poly-uria. High production of urine as the remaining kidney adjusts to the higher work-load.
• You will be discharged as soon as your renal function has stabilised and you can function independantly.
• Allow for 6 weeks for stabilization of symptoms.
• Restrict fluid intake to less than 3 L per day.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
• Don’t hesitate to ask Jo if you have any queries.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Risks

• Minimal Blood loss.
• Wound Infection.
• Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
• Prolonged hospital stay due to impaired renal function recovery.
• Dialysis as discussed by your Nephrologist, if pre-operatively indicated.
• NB! Each person is unique and for this reason symptoms vary!

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Nephrectomy Radical Laparoscopic