Laparoscopic Nephrectomy is a minimally invasive surgical procedure that involves multiple keyhole-sized incisions to remove either part (partial) or whole (radical/total) of your kidney. Kidneys help remove waste and extra fluids from the blood and maintain the body's chemical (like sodium, calcium, and potassium) balance. They also produce and secrete hormones that regulate blood pressure and stimulate the bone marrow to produce red blood cells. Any tumor or pathological disease of the kidneys may impair its function and cause life-threatening complications that are surgically treated through nephrectomy.
Any disease or pathological condition (like a tumor, kidney stone, or injury) involving the kidneys can negatively impact their function and morphology. If left untreated, they can lead to several life-threatening complications and may also be fatal (a condition that causes the death of a person). Nephrectomy is a life-saving procedure that involves removing either one (unilateral) or both kidneys (bilateral).
Laparoscopic nephrectomy is an advanced, minimally invasive procedure (does not involve large incisions or cuts) that uses a special surgical instrument known as a “Laparoscope.” This thin, long, hollow tube-like instrument consists of a light source and a tiny camera.
There are different types of nephrectomy procedures, which include:
- According To The Extent of Tissue Removal:
- Partial Nephrectomy: It is a kidney-sparing surgery to remove only the part containing the tumor and leave behind healthy kidney tissues.
- Radical Nephrectomy: It is the complete removal of the whole kidney, fatty tissues surrounding it, and a part of the ureter (a tube connecting the kidney to the bladder).
- According To The Surgical Techniques:
- Open Nephrectomy: Traditional approach involving a single large incision (cut) in your abdomen.
- Laparoscopic Nephrectomy: A less invasive method that involves multiple keyhole-sized incisions.
- Robotic Nephrectomy: An advanced surgical approach that uses robotic technology to assist surgeons in performing the procedure.
This article will explore the benefits and risks of partial and radical laparoscopic nephrectomy, the procedure.
A laparoscopic nephrectomy is an effective procedure recommended for removing severely damaged, scarred, or non-functioning kidney tissue due to injury, disease, or other pathologies.
Partial Nephrectomy Indications:
- Presence of only one kidney
- Nephron-sparing surgery (NSS) for renal cell carcinoma (cancer) to preserve the kidney function
- Renal tumor <4 cm in young and healthy patients with a healthy contralateral kidney
- If renal cell carcinoma is inherited (passed down through families)
- Kidney damage due to renal stones
- High blood pressure due to improper blood supply to the kidneys
- Complete renal failure
- Conditions that may compromise the functioning of the collateral kidney in the future (moderate renal failure, kidney stones, etc.)
Radical Nephrectomy Indications:
- Localized stage I (the tumor is <= 7cm) and stage II (the tumor is >7 cm) renal tumors
- During a kidney transplant, when you need to donate the kidney
- Severely damaged kidney due to high-impact trauma.
Although minimally invasive, laparoscopic nephrectomy requires pre-procedure preparation for optimal results and quick recovery with minimal postoperative complications.
- You must consult a urologist (a doctor specializing in the diseases of the urinary tract) when you experience symptoms of kidney damage that include unexplained weight loss, hematuria (blood in the urine), swollen ankles and feet, and increased urination to name a few.
- Your doctor will review your history about your symptoms, allergies, previous surgeries, and the presence of any pre-existing conditions like asthma, diabetes (increased blood sugar levels), thyroid, heart or lung diseases, and other blood disorders.
- An MRI (Magnetic Resonance Imaging) or a CT (Computed Tomography) scan will be performed to evaluate the severity of the disease.
- List out the medications you have been taking, including blood thinners, anti-inflammatory medications, and other vitamin and herbal supplements. Your doctor may advise you to discontinue them 2 weeks before the procedure.
- You must quit smoking and alcohol 1 to 2 weeks before the procedure to avoid the increased risk of bleeding.
- Pre-procedure blood tests, urine analysis, and ECG (electrocardiogram) will be conducted to evaluate your overall health.
- Nephrectomy is done under general anesthesia; hence you must fast 8 to 12 hours before your scheduled surgery to prevent aspiration of food particles into your lungs.
Donor Preparation Before Nephrectomy For Renal Transplant:
- Preparation before a kidney transplant is important since it greatly reduces the chances of post-surgery transplant rejection.
- Your medical history will be reviewed to evaluate if you suffer from pre-existing conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), asthma, or any heart and blood-related disorders.
- A blood type compatibility test will be conducted to evaluate your eligibility for donating the kidney.
- An evaluation from a medical counselor will ensure the nephrectomy and transplant are done willingly and not under pressure.
Laparoscopic nephrectomy is a minimally invasive procedure under general anesthesia (GA). The procedural steps are discussed below:
- On the day of the surgery, the nurse will check your vitals (blood pressure, oxygen level, pulse, heart rate, and urine output).
- You will be wheeled to the operating theatre (OT) at the scheduled time.
- The surgical site is prepped with an antiseptic solution to disinfect the surface, remove contaminants, and prevent post-op infections.
- Your anesthesiologist will administer GA through IV (intravenous) infusion.
- You will be made to lie supine (lie flat on your back).
- A urinary catheter (a tube to drain urine) will be inserted and kept in place for 2 to 3 days post-op.
- Your surgeon will make 3 to 4 small keyhole-sized (around 0.5 to 1 cm) incisions (cuts) around the abdomen.
- Carbon dioxide gas is injected through one of the incisions to inflate the abdomen for a clear view of the surgical site.
- A laparoscope is inserted through one of the incisions, and tiny surgical instruments are through other incisions.
- There are two types of nephrectomy depending on the extent of kidney tissues removed:
Partial Nephrectomy:
- Once the surgical site is inflated, the images from the surgical site are projected on the screen.
- The blood vessels to the damaged kidney are ligated (tied off) to stop the blood flow during surgery temporarily.
- The tumor and the diseased kidney around the tumor will be carefully removed, leaving behind the healthy kidney tissues.
- This prevents renal insufficiency.
- If the tumor has spread to the collecting system of the kidney (renal pelvis and part of the ureter), a double J-shaped stent will be placed to facilitate proper urine flow.
- The procedure will usually take around 2 to 3 hours.
Radical Nephrectomy:
- Once the surgeon makes small incisions and inserts a laparoscope, images of the inside of the abdominal cavity are taken and projected on the screen.
- The surgeon will insert tiny surgical cutting instruments through the incisions made.
- The ureter, renal artery, and vein are separated, and the kidney is removed.
- Other structures removed along with the kidney include:
- Lymph nodes (small organs that help to fight infections)
- Adrenal glands (organs located above the kidneys that produce hormones)
- Ureter (a tube that drains urine from kidneys into the bladder
- Radical nephrectomy may take around 2 ½ to 4 hours.
- The wound will be closed using absorbable sutures (stitches), and a surgical dressing is placed over it.
You are expected to stay in the hospital for 2 to 3 days following a laparoscopic nephrectomy to monitor your kidney function.
- After the surgery, you will be observed in the recovery room for at least 2 hours while your vitals are monitored.
- Once stabilized, you will be shifted to your ward.
- You are expected to have mild pain and discomfort once the effect of anesthesia wears off. Painkillers will be prescribed to manage pain and discomfort.
- A urinary catheter (a tube to drain urine) will be placed for the initial few days during recovery.
- Your kidney function will be closely monitored through blood analysis and urine output (collected in the catheter bag).
- You will be on a liquid diet for 24 hours post-surgery and gradually progress to semi-solid foods.
- Once stabilized, you will be sent home.
- At home, try to rest as much as possible since your body will need time to heal.
- Remember to walk and move around to prevent the formation of blood clots and improve blood circulation.
- Refrain from lifting heavy objects and strenuous exercises for at least 2 to 3 weeks post-surgery.
- Avoid foods that may constipate you, such as high-fat dairy products (cheese, butter), and a high-protein diet (red meat) for the initial days of your recovery.
- Avoid alcohol and smoking since it may delay wound healing.
- Follow your surgeon's instructions for proper recovery and prevent postoperative complications.
- Recovery may usually take around 4 weeks after laparoscopic nephrectomy.
Laparoscopic nephrectomy is the most recommended surgical approach when compared to an open nephrectomy due to the following benefits:
Benefits:
- It greatly improves kidney function since the remaining kidney can compensate for the loss of the removed kidney (especially after a partial nephrectomy).
- Enhanced patient survival since you will be relieved of the symptoms.
- Aids in removing kidney tumors and pathologies that would otherwise cause life-threatening emergencies if left untreated.
- The procedure involves small incisions with minimal scarring.
- Moderately less painful when compared to open nephrectomy involving large incisions.
- Involves less bleeding and post-op complications.
- Reduced hospital stay.
- Quick recovery and return to normal activities.
Risks:
Laparoscopic nephrectomy is a relatively safe procedure; however, there could be a few possible risks:
- Sometimes the remaining kidney may fail to compensate for the lost kidney, eventually leading to renal (kidney) dysfunction and chronic (long-lasting) kidney disease.
- Risk of infection with associated symptoms like high-grade fever (>103 ?), chills, and body aches.
- Allergic reactions to anesthesia cause hives, rash, itching, nausea, vomiting, dizziness, confusion, and breathing difficulties.
- Blood clots could dislodge in the bloodstream and travel to other internal organs like the lungs (pulmonary embolism).
- Possible nerve damage causing numbness at the surgical site.
- Persistent pain at the surgical site.
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