Treatment

A laparoscopic nephrectomy removes the kidney by using laparoscopic equipment. Long thin instruments are passed through up to five small incisions made in the flank, each about 1cm in length. The abdomen is first filled with carbon dioxide, which separates the tissues to allow for vision during the surgery. A camera is then passed, giving the urologist a detailed picture inside the abdomen. The other incisions are used to pass cutting and suturing instruments so the blood supply to the kidney can be isolated and tied off and the kidney removed either with or without its surrounding structures. A wound drain is then inserted to drain any wound ooze. This is usually stitched in place and stays in for 1 – 2 days.

When the operation is finished, the carbon dioxide air is removed from the abdomen and the cuts are stitched closed with dissolving stitches. The areas are then covered with small plasters. A catheter (drainage tube which drains urine from the bladder) is also inserted to monitor the urine output from the remaining kidney. The catheter usually stays in for 1 – 2 days, or until you are up and about.

Laparoscopic Nephrectomy takes approximately 2 – 4 hours to perform and involves a hospital stay of around 1 – 2 nights.

What are the risks involved with a nephrectomy?

With all surgery, there is a risk of infection and blood loss. The kidneys have a large blood supply and there is always some bleeding involved with surgery. Antibiotics are often given during the operation to prevent infection. In a small number of cases, a blood transfusion may be needed to compensate for blood loss during surgery. If you do need a blood transfusion and you want to refuse one, it is vital that you tell your surgeon and nurse prior to your operation. It is possible to donate some of your own blood prior to surgery. If you would like to do this please discuss it with your surgeon.

In any laparoscopic surgery, there is also the risk that the surgeon may need to proceed to open surgery, requiring a single, larger incision in the flank. This happens rarely and can be due to equipment failure, excessive bleeding or other difficulties encountered during the surgery.

Your Consent

We need your permission for your operation to go ahead. Before you sign the consent form it is important that you understand the risks and effects of the operation and anaesthetic. Your doctor and the nurse will discuss this with you, should you have any questions, your nurse or doctor would be happy to answer these.

If you would like your kidney returned to you for personal reasons, please discuss this with your family and inform your nurse and surgeon before your operation.

About Your Anaesthetic

You will NOT be allowed to eat or drink anything for at least six hours before your surgery. This includes chewing gum and sweets.

You will have a general anaesthetic where you will be asleep throughout the operation and remember nothing of it. Feel free to discuss the anaesthetic and any questions, with your anaesthetist.

Your Operation

On admission, you will be informed of an approximate operation time and prepared for theatre by your nurse.

You may be fitted with T.E.D. stockings that help aid circulation and prevent blood clots, which there is always a slight risk of with surgery. You may also be instructed about special deep breathing and leg exercises that you should do after surgery.

If a shave of the surgical site is required, this is done in theatre once you are asleep.

You may be given some tablets before theatre. These are charted by your anaesthetist and may include tablets for tension, nausea and pain prevention.

You will be escorted to the theatre, where you will be transferred to the theatre table. Anaesthetic staff will then insert a drip in your arm and will attach various monitoring devices. Once you have been completely prepared and given your anaesthetic, surgery will begin.

When the operation is completed, you will go to the recovery room where you will be cared for until you are ready to be transferred to the ward.

After Surgery

Your nurse will check your blood pressure and pulse regularly. Your wound and the drainage from it will also be monitored closely.

You will have a drip in your arm to make sure you receive adequate fluids. This will be removed once you are drinking normally. You can usually drink after surgery and you may eat once you are tolerating fluids.

Your urine will drain from your bladder, through the catheter into a bag. Your nurse will measure your urine output every hour. The urine is likely to be blood stained, this usually clears within the first 24 hours. The catheter is held inside your bladder by a small, inflated balloon, which prevents it from slipping out.

You will have a drip in your arm to make sure you receive adequate fluids. This will be removed once you are drinking normally and the post-operative antibiotic treatment is complete. You can usually drink when you return to the ward and you may eat once you are tolerating fluids. Routinely, this is a very well tolerated procedure with minimal pain experienced and our aim is to keep you comfortable, so please tell your nurse if you have any pain or discomfort so you can be given the appropriate care. At all times, your nurse is there to help you, please ring your bell if you need assistance and your nurse is not nearby.

You will be able to be up and about as able but may need assistance the first time you get up out of bed. You should do regular deep breathing and leg exercises after surgery until you are fully mobile. The physiotherapist may come and see you to give further instructions.

Day one after your operation

You will be able to eat and drink, as you feel able. You will be able to walk to the shower and be up and about. You will be given regular pain relievers, such as Panadol to help keep you comfortable. If the drainage from your wound drain is minimal it will be removed. Your catheter will also be removed when you are mobile and your urine output is sufficient. If your drain has been removed, you have completed your course of intravenous antibiotics, have been taught catheter cares and are comfortably up and about, you will be able to go home.

Going Home

You will be given a discharge letter that contains helpful information about how to care for yourself when you return home. You will be sent an outpatient appointment for follow-up with the specialist 4-6 weeks after your operation, we will also send a letter to your own doctor about your operation, and the details of your treatment while you were in hospital.

Once Home

You should take regular pain relief as instructed by the nurse prior to your discharge. This helps to keep you comfortable so you are able to get about easier, do more and hence feel better.

Your wounds should heal within a few days. However, beneath your skin the muscle layers will take longer to heal. For this reason it is important to avoid any strenuous activity, heavy lifting and straining for 2 – 3 weeks. This includes things such as mowing lawns, gardening, vacuuming and lifting heavy washing baskets.

You can shower or bath at home as usual. You may need to place a dry dressing over your wounds to collect any slight ooze so it does not stain your clothing or get dirty.

Contact your own doctor if:

• Any of your wounds become red, hot, swollen, painful or continue to discharge
• Your urine becomes cloudy, offensive smelling or you have any other signs of a urine infection
• You have any concerns at all

The important thing to remember is that you are not alone…

Many people like you have undergone laparoscopic nephrectomy with a high degree of success. Humans can survive easily on one kidney and there is no reason why you should not be able to function as you did prior to your surgery. A positive attitude on your part will make everything easier. There is every reason to believe that you will experience a successful outcome.

While you are in hospital, we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask your nurse who will be more than happy to help.