What does the procedure involve?
This involves removal of the kidney for suspected cancer of the kidney through several keyhole incisions. It requires the placement of a telescope and operating instruments into your abdominal cavity using 4-5 small incisions. The adrenal gland may also be removed and one incision will need to be enlarged to remove the kidney
What are the alternatives to this procedure?
Observation, open surgery
What is laparoscopic surgery?
Laparoscopy (otherwise known as “keyhole surgery”) is a form of minimal access surgery. This involves performing operations which are traditionally done by an “open” method but using “keyholes” instead. A number of urological procedures are now being performed by this method. It has been shown to be safe and effective for kidney surgery and is the preferred surgical method for the removal of a kidney.
Your urologist will discuss the details of the procedure with you whilst you are an outpatient, outlining the procedure as part of your consent. You should be aware that there is a small chance (less than 1%) that your procedure may need to be converted to an open procedure. For this reason, if you are insistent that you would not agree to an open operation under any circumstances, we would not be able to proceed with the laparoscopic operation.
What should I expect before the procedure?
You will usually be admitted on the same day as your surgery. Unless done on the same day as your urology clinic appointment, you will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the surgical team which will include the Consultant, Specialist Registrar, and your named nurse.
You will need to wear anti-thrombosis stockings during your hospital stay; these help prevent blood clots forming in the veins of your legs during and after surgery.
What happens during the procedure?
A full general anaesthetic will be used and you will be asleep throughout the procedure. You will be transferred to the operating theatre on your bed and you will be taken first to the anaesthetic room. They may put a drip in to your arm to allow them to access your circulation during the operation. You will be anaesthetised and taken into the operating theatre. The kidney is disconnected through several keyhole incisions and put into a bag which is then removed by extending one of the keyhole incisions.
A bladder catheter is normally inserted during the operation to monitor urine output and rarely, a drainage tube may be placed through the skin into the bed of the kidney.
What happens immediately after the procedure?
It is fine, and in fact you will be encouraged, to eat and drink as soon as you feel able to after surgery. You will be encouraged to mobilise as soon as possible after surgery. This helps to prevent blood clots forming in your legs, a chest infection from developing, and also decreases any disturbance to your bowel function. The catheter is normally removed on the morning after surgery. The expected hospital stay is 2 to 3 days.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
There is a small risk of bleeding with surgery, and you may require a blood transfusion. Rarely, bleeding during the operation may necessitate conversion to open surgery (involving a larger cut in the skin). Sometimes, the histological abnormality (as checked under a microscope) may eventually turn out not to be cancer.
What should I expect when I get home?
Before you leave hospital, the team will ensure you are safe to be discharged home. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers. All the wounds are closed with absorbable stitches which do not require removal. It will take at least 14 days to recover fully from the procedure and most people can return to normal activities after 2-6 weeks.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, increasing abdominal pain or dizziness, please contact your GP immediately.
Are there any other important points?
A follow-up outpatient appointment will normally be arranged for you around 6 weeks after the operation. At this time, we will be able to inform you of the results of pathology tests on the removed kidney. It will be at least 14-21 days before the pathology results on the tissue removed are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.
If a cancerous growth is found in the removed kidney, you will be closely followed in clinic with blood tests every 6 months, and chest x-rays and scans less frequently.
After removal of one kidney, there is no need for any dietary or fluid restrictions since your remaining kidney can handle fluids and waste products with no difficulty.
