Introduction
Nephrectomy is the surgical removal of a part of or whole kidney. Nephrectomy is indicated in conditions such as kidney cancer, end-stage kidney disease, or kidney transplant. Nephrectomy is carried out in open surgery and keyhole surgery or laparoscopic surgery. In open surgery, the surgeon makes an incision on the side of the abdomen to carry out the procedure. Whereas in laparoscopic surgery, a minimally invasive approach is carried out.
What Are the Benefits of Laparoscopic Nephrectomy?
- Laparoscopic surgery avoids the formation of big scars.
- The hospital stay is for a shorter period of time.
- The postoperative pain is lesser as compared to open surgery.
- The recovery post-surgery is faster.
- The individual can resume normal activities within a shorter period.
What Are the Indications for Laparoscopic Nephrectomy?
Laparoscopic nephrectomy is indicated in:
- Benign Symptomatic Non-Functioning Kidneys- Chronic kidney disease.
- Hydronephrosis- Swelling of the kidneys due to fluid deposition.
- Chronic Pyelonephritic Kidneys- This is a bacterial infection of the malformed kidneys.
- End-stage Renal Disease- Permanent damage to the kidneys.
- Renal Hypoplasia- Abnormally small kidneys.
- Dysplastic Kidneys- A condition where the internal structures of the kidneys do not develop properly.
- Donor Nephrectomy- Kidney transplantation.
- Malignant Renal Condition- Kidney cancer.
What Are the Contraindications of Laparoscopic Nephrectomy?
Laparoscopic nephrectomy is not indicated in:
- Uncorrected coagulopathy.
- Severe cardiopulmonary disease.
- Previous multiple abdominal surgeries.
- Previous kidney surgery.
- Malignant kidney conditions.
What Happens a Day Before the Procedure?
Before the procedure begins, several tests are performed to assess the individual's condition during surgery. One has to undergo blood tests, urine tests, ECG (electrocardiogram), and MRSA (Methicillin-resistant Staphylococcus aureus) screening. The patient is advised to stop certain medications if they are taking any. The patient is advised to stop eating six hours before surgery and drink water two hours before surgery.
How Is the Surgical Procedure Carried Out?
Like any other surgery, general anesthesia is given to the patient. The surgical procedure takes around three to four hours. During laparoscopic nephrectomy, three to four small keyhole cuts or incisions of less than one centimeter are made in the abdomen. A laparoscope, a thin tube with a video camera attached to one end, is inserted into the abdomen. A few tiny surgical instruments are inserted along with it. The laparoscope gives ten times magnification of the operative field, thus helping the surgeon to perform the surgery with ease. The tummy is filled with carbon dioxide gas to create a greater area for the surgeon to perform the procedure. The carbon dioxide gas is later removed from the abdomen after the end of the surgery. The kidney is removed and separated from the surrounding organs, such as the liver, spleen, and intestines. The vessels that supply blood to the kidneys are pinched with the help of clips and divided for safe and effective removal of the kidneys involving very little blood loss. The tumor inside the kidneys, surrounding fatty tissues, and lymph nodes are also removed. The adrenal glands are also removed if the cancer is near them. Once the kidney is removed, it is immediately kept inside a plastic sac and retrieved from the abdomen through one of the abdominal incisions. Finally, the cuts are stitched to minimize scarring.
The surgical procedure takes around two to three hours, depending on the case.
What Happens After the Surgery?
After the surgery, the individual has transferred to the recovery room until the effect of anesthesia wears off fully and they are awake. After waking up, if one feels pain, painkillers are given orally or intravenously. A few tubes might be present after the surgery-
- Drip: A drip is put into a blood vessel (vein) to administer fluids unless and until one can normally drink through the mouth. It is removed the next day.
- Urinary Catheter: A tube or catheter is placed to check the urine output, helping the individual pass urine easily. The catheter is removed once the individual can walk.
- Drain: A small plastic tube or drain is attached to the drainage bag, collecting blood-stained fluids from the injury site. Once the drainage is very less or absent, the tube is removed. Generally, the drainage tube is removed the next day.
It is common to have a little shoulder or stomach pain for a few days. This pain is there because of the usage of carbon dioxide gas to inflate the abdomen. This pain is mild, but if the individual is uncomfortable, then a strong dose of painkillers can be administered. In case one feels nausea, then anti-vomiting drugs are administered.
The following day, the individual is asked to walk for shorter periods to help blood circulation. The hospital stay is around one or two days. After which, the individual is released.
How Is the Recovery After Surgery?
The recovery period takes around two to three weeks after the surgery.
- Driving within the first two weeks is prohibited.
- Work within the first few weeks should be minimal.
- Heavy, strenuous work is best avoided for four to six weeks.
- Exercises should be resumed slowly, beginning with short and gentle forms.
- Strenuous exercises should be avoided for a period of three to four weeks.
- One is advised to drink a lot of fluids daily to keep the kidneys healthy and functioning properly.
- One must abstain from sexual activity three to four weeks after the surgery.
What Are the Risks and Complications of the Surgery?
Laparoscopic nephrectomy is safe and minimally invasive. But like in any other surgical procedure, risks and complications are involved. They include:
- Bleeding- Blood loss during this surgery is very less. Therefore, a blood transfusion is required in less than five percent of cases.
- Infection- Individuals undergoing surgery are administered intravenous antibiotics to reduce the chances of developing any infection after the surgery. If one develops any symptoms of infections such as fever, drainage of blood-stained fluids from the cuts, urinary discomfort, pain, etc., then the doctor should be informed immediately. A chest infection may occur as a side effect of anesthesia and can be prevented by following deep breathing.
- Hernia- Hernia is the bulging out of an organ or tissue through an opening. A hernia is rare in laparoscopic surgeries since the wounds are sutured securely.
Conclusion
Laparoscopic nephrectomy is a low-invasive surgical procedure that involves making small keyhole incisions to carry out the surgery. It is of greater advantage as compared to open surgery. The recovery period is less. Although there are risks involved, they can avoid them with proper management.
