Nephrectomy (removal of the kidney) is indicated in patients with an
irreversibly damaged, non functioning kidney as well as in situations
of kidney masses which are presumptive renal cell carcinoma, or kidney
cancer.
. Laparoscopic Nephrectomy
Postoperative Pain Medication 32 mg IV Morphine
Blood Loss 289cc (50-2,000)
Hospital Stay 3.8 Days (2-14)
Cosmetic Result 2.5cm Combined Size or 1 inch
Time to Nonstrenuous Activity 2.2 Weeks
Time to Return to Work 3.8 Weeks
Time to 100% Recovery 4.0 Weeks or 1 month
Why is a laparoscopic nephrectomy better for the donor?
This procedure does take about an hour longer than the traditional
process. However, donors experience less pain, are ready for discharge
in two days, and can return to work in two to four weeks. Under the
open surgical procedure, donors remain hospitalized for five to seven
days and often take six weeks to recuperate.
In 1999, Methodist Dallas performed the first successful laparoscopic
nephrectomy in Texas, allowing the donor to be released within 48
hours of the procedure.
Are more people willing to donate due to this process?
Because a laparoscopic nephrectomy involves less pain, a shorter
hospitalization and a more rapid return to normal activity for the
donor, we have found that relatives and friends of patients needing
transplants are more willing to donate. Donor options are constantly
expanding, and newer options such as faired kidney exchange, high
sensitization protocol, and altruistic stranger donation are becoming
available.
Laparoscopic nephrectomy is a standard of care. This surgery is
performed via 3 small incisions (0.5 to 1cm in size) and has a
significant number of benefits to the patient including decreased
pain, shorter hospitalization (about 2 days), less blood loss, lower
requirements for pain medication, reduced convalescence, and a more
rapid return to full activity. Laparoscopic nephrectomies have been
performed for over a decade, and data has shown this procedure to
produce cancer control identical to that of open radical/total
nephrectomy. At this time, laparoscopic radical/total nephrectomy for
the treatment of renal tumors is a standard of care.
Pre-admission: Within 1 week prior to your surgery, you will be
scheduled for pre-admission testing. These tests generally consist of
a complete blood count, electrolyte panel, urinalysis, urine culture,
chest x-ray and, when indicated, an electrocardiogram. Before the
procedure, you will require medical clearance from your primary care
physician. If you do not have an internist, you may request one or
your urologist will recommend one.
Operative phase: The evening before your surgery, you will not be
permitted to eat or drink after midnight. This ensures that no food is
in your stomach prior to induction of anesthesia. Before your
procedure, an anesthesiologist will see you. You will be given
medication which will decrease anxiety and induce relaxation and, once
you are in the operating room, you will then be given general
anesthesia. This medication is given by the anesthesiologist who will
be at the head of the table. This medication will prevent you from
feeling any pain during surgery and make you unaware of what is going
on around you at this time. The procedure is then performed by the
surgical team. It will be necessary for you to have a bladder catheter
inserted to help measure urine output during the operative and
postoperative periods as well as assist your urination after the
procedure.
The operative position will be a modified lateral position with the
affected site upright 45degrees. Three 0.5 to 1cm small skin incisions
will be created as shown in the following figure. The entire surgery
will be performed through these incisions.
After the operation, the affected kidney will be extracted either
intact or morcellated, or fragmented into pieces after being placed in
a special specimen bag. The wounds will be closed and covered by
tapes. There is no need for removal of any stitch in the future.
Postoperative phase: After the procedure is completed, you will be
placed back on the OR stretcher with total help from the surgical team
and wheeled into the recovery room where you will be monitored by the
recovery room nurses. They will check your blood pressure, pulse,
respirations, temperature and drainage from your tubes. When you are
completely awakened from anesthesia, you will return to your room and
the floor nurses will then take care of you. You may still be drowsy
from the anesthesia, but as this begins to wear off, you might
experience some discomfort where the surgery took place. You will be
given an injection of pain medication upon request and the
effectiveness of the medication will be monitored. If it is not strong
enough for the pain you are experiencing, it may be increased
according to your doctor's orders. The pain should begin decreasing
each day in which case the dosage will be adjusted. The medication
will eventually be changed to pills when you are tolerating fluids and
food, usually within 4-48 hours.
Getting ready for discharge: The bladder catheter is always removed on
the first postoperative day. A clear liquid diet will be started on
the first postoperative day. The admission is usually a period of time
between 1 to 3 days. Upon discharge, you will be given printed
discharge instructions. Please ask for these before you leave the
hospital.
Policy of follow up: You should make an appointment to see your
urologist within 10-14 days following your discharge. The pathologic
report will be discussed with you as well as an inspection of your
operative wounds. In case of malignant nature of the disease, you
should be followed up with xray studies every 6 months, 1 year, 1 and
a half years, 2 years, and so on for at least five years. The studies
include CT scan, chest X-ray film, or blood tests to be arranged as
indicated. Close surveillance will be performed to detect any
possibility of tumor recurrence or metastasis for the malignant
diseases in the future.
Comparison of the recovery factors between the kidney donor and kidney recipient
The risks of the procedure seem to be similar to those of the open
operation for both the
donors and the transplant patients (the patients who received a
donated kidney). Up to 1 in 5
donors who had the new procedure had problems during or after the
operation. Some of the studies of the open procedure did not give any
information about what happened to donors. But the information that
was given showed that up to around 1 in 3 donors had problems during
or after the open operation. For the transplant patients, there didn?t
seem to
be any differences between the problems when the donor had had the new
procedure and when
the donor had had the open operation. But again, some of the studies
didn?t say what happened to all the transplant patients. Where
information was given on problems affecting the tube joining
the kidney to the bladder, the numbers for comparison were:
? 3 to 10 transplant patients in 100 had this type
of problem where the donor had had the laproscopic
procedure
? 3 to 6 transplant patients in 100 had this type
of problem where the donor had had the open
operation.
What the experts said
The experts said that the main problems with laparoscopic live donor
simple nephrectomy were
likely to be bleeding and damage to other parts of the body near to
the kidney. In some cases, a
problem with this procedure may mean that part way through, the
surgeon decides that it would
be best to change to the open operation. |
