Dr Jo Schoeman
Urological Surgeon

        

Laparoscopic (Radical) Nephrectomy

Product Summary: AMA rates

Laparoscopic radical nephrectomy, with para-aortic, or para-caval nodes

Item Number: 10cm 36528, 105; 10cm 36529, 105

For renal cancers contained in the kidney. This is a intended curative procedure, depending on staging.

Also for symptomatic, non-functional kidneys. Least invasive procedure with quick recovery.

Why is it done?

  • Incidental finding of a solid renal mass larger than 3cm suspicious of a renal cancer.
  • A symptomatic non-functioning kidney.
  • Usually asymptomatic.
  • Late symptoms include:
    • Hematuria.
    • Palpable Mass.
    • Flank pain.
  • Curative process for Renal Cell Carcinoma.
  • Staging should be negative ie. No spread of tumour.
  • Staging with:
    • CT abdomen and chest.
    • Bonescan.
    • MRI if in Renal Failure or Contrast.
    • Allergy.
  • Risk for post-operative dialysis will have been discussed prior to your surgery by means a referral; to a Nephrologist.

Very Important!

The correct side for surgery should be checked:

  • CT scan present.
  • Your approval.
  • Prior to anaesthesia being.
  • commennced.

How is it done?

  • Patients will receive a general anaesthesia, unless contra-indicated.
  • Prophylactic anti-biotics is given.
  • An indwelling catheter is placed.
  • The correct kidney is identified and marked while you are a.
  • Depending on the side of the tumour 3-4 incisions will be made: 1 for the hand-port of approximately 8cm depending on the amount of sub-cutaneous fat present 1 for the camera-port 1 for the working-port (1 for the liver retractor on the right)
  • The colon is reflected to reveal the retro-peritoneal space
  • The ureter is identified and cleared up to the hilum
  • The arteries are identified and tied off and cut first. More than 1 can be present
  • Then the vein/ viens are tied and cut.
  • The rest of the kidney is mobilized with its surrounding fat and removed.
  • The adrenal gland is also removed in large tumours and upper pole tumours.
  • Lymphnodes surrounding the blood supply to the kidney will be removed if the tumour is larger than 4 cm.

What next?

  • You will spend up to 3-5 nights in hospital.
  • You will have a catheter for that time.
  • A drain for 2-3 days.
  • You will a trial without the catheter on the 3rd day.
  • Renal functions will be checked daily.
  • You may enter a phase of poly-uria. High production of urine as the remaining kidney adjusts to the higher work-load.
  • You will be discharged as soon as your renal function has stabilised and you can function independantly.
  • Allow for 6 weeks for stabilization of symptoms.
  • Restrict fluid intake to less than 3 L per day.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
  • Don’t hesitate to ask Jo if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Risks

  • Minimal Blood loss.
  • Wound Infection.
  • Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
  • Prolonged hospital stay due to impaired renal function recovery.
  • Dialysis as discussed by your Nephrologist, if pre-operatively indicated.
  • NB! Each person is unique and for this reason symptoms vary!

Laparascopic Radical Nephrectomy Laparascopic Radical Nephrectomy (333 KB)