Tuesday, 24 January 2017

Laparoscopic Nephrectomy

This surgery is done to remove the diseased or cancerous kidney. As opposed to traditional open surgery involving a 15 cm incision, this is a minimally invasive procedure carried out with very tiny 1 cm cuts plus a 4-6 cm cut to remove the diseased kidney.

Why is a Nephrectomy required?

There may be several reasons why a kidney may have to be removed. A kidney may be partly working and being left in place could be a basis for infection or pain, at times the kidney may have incurred damage or there may be a cancer present the usual treatment for which is to remove the kidney. Where there is a kidney cancer present at times it becomes necessary to remove the adrenal gland as well that lies above the kidney. Also in certain cases of kidney cancer (transitional kidney cancer, TCC) there is a high risk of reoccurrence of cancer in the ureter. This might involve another surgery to remove the ureter. The doctor will discuss the reasons with you if a kidney has to be removed.
With your other kidney functioning normally you can easily manage a healthy lifestyle without major changes.



The risks and side effects

Every operative procedure carries some risk associate with it however, these are small in comparison to not carrying out the operation. Although these complications are well recognised, the majority of patients do not have problems after a procedure.

Occasional risks

An infection may occur where the incision was made requiring further treatment. If the wounds are red or inflamed you would need to see the doctor.

Rare risks

The surgery may cause bleeding that requires blood transfusion or the surgeon may have to carry out an open surgery if visibility using keyhole technique is difficult. This occurs in five per cent cases.
During the procedure the lung cavity may be entered, but this can be repaired without any further incision.

Very rare risks

Injury to the adjacent organs may be caused causing the surgeon to move to open surgery.
Issues with anaesthetic or heart and blood vessels complications may occur requiring admission to ICU. Such complications may cause a chest infection, stroke, blood clots or a heart attack.
How long does the operation take?
Every case is different however, on an average the procedure takes about 2-3 hours.


Before the operation

A pre operative assessment is carried out to sort out any health issues that might delay the surgery.  The surgeon will review your medical history as well as any outside reports, records, and outside X-ray films (e.g. CT scan, MRI, sonogram). Also you are advised to bring along any medication you take on daily or ad-hoc basis.

After the operation

You will be in the recovery room where the nursing staff there will look after you until you are ready to return to your ward. You will be on an intravenous drip until you are in a position to drink fluids normally. Although you can have some oral fluids fairly soon after the operation, you will be able to drink normally and eat something light by the next day. While you are returned back to your ward you will have a drainage tube (catheter) put in place to drain urine from the bladder. This allows the nursing staff to have an assessment of the quantity of urine excreted within first 24 hours of the surgery. This is usually removed with two days post surgery. However, in case the ureter is also removed the catheter is left in place for a longer duration to allow for healing to take place. Post surgery it is quiet normal to experience shoulder tip pain or wind like pain in the abdomen. This is because during the surgery the surgeon uses gas to inflate the abdominal cavity so he can better see the kidney. This is easily treated with simple painkillers. The wounds have dissolvable stitches and are dressed regularly changing dressing only if they are heavily soiled and become looses. Most patients are also given injections post operatively on a daily basis to prevent blood clots. In cases where a person may be more prone to a higher risk of clots injections are continued for up to 4 weeks.

Getting out of bed

You will be encouraged to get up and about as soon as possible, usually the day of surgery. This is to prevent complications such as a chest infection, pressure sores or a deep vein thrombosis (clot in the leg veins).
By day two you should be out of bed for most part and also be able to walk short distances. Once the catheter is  removed and you are able to pass urine satisfactorily you shall be discharged.

At Home

You are advised to do light walking while refraining from lifting anything heavy or driving for at least 2-4 weeks after the operation. A healthy diet containing ample fruits and vegetables is good to keep your bowels regular. You can return to your office when you feel fit. In most cases one can return back to full physical activity with 3-4 weeks after the surgery. However, in case of an open surgery it may take up to 8-10 weeks. 

The benefits of this minimally invasive procedure

This minimally invasive approach has the advantage of improved cosmetic look, reduced pain, blood loss, shorter hospital stay and fewer post operative complications as compared to conventional open surgery with similar cure rates.

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