Laparoscopic Nephrectomy (keyhole surgery for removal of kidney)

Why remove the kidney?

The kidneys are a pair of organs at the back of the abdomen that filter the blood to remove waste products, which they convert to urine.

The most common reason to remove a kidney is the presence of a mass (lump) suggestive of cancer. If it has a typical appearance of cancer on imaging a biopsy is NOT usually indicated. Other reasons to remove a kidney are chronic infections or a blockage that has severely damaged the function fo the kidney.

What are the advantages of laparoscopic nephrectomy vs open surgery?

Smaller incisions (typically three 0.5 – 1 cm with one 4-6 cm to remove the kidney)
Less pain and less need for pain medications
Earlier discharge from hospital (1-3 days vs 5-10)
Less blood loss and earlier recovery and return to normal activities including work

Not every patient is suitable for laparoscopic nephrectomy as sometimes it is safer to remove the kidney with open surgery.

How long does a laparoscopic nephrectomy take?

Usual operating time is between 1 and 3 hours (total theatre time will be longer due to pre operative preparations). Operating time depend on numerous factors such as patient size, previous surgery, size and location of the tumour.

What should I expect after laparoscopic nephrectomy?

You will usually be admitted to the surgical ward with a drip in the arm for intravenous fluids, catheter in the bladder and a surgical drain coming out of the abdomen (all usually removed the next day).

You may be given a pump to deliver pain relief medications in the first 24 hrs (PCA).

You can usually eat and drink once you are no longer drowsy/nauseous within 12 hours of the operation.

When can I go home following laparoscopic nephrectomy?

Once you are eating and drinking, walking around unassisted, your pain can be controlled with oral medications only and your postoperative blood tests are satisfactory. Most patients will go home after 48 hours after operation. The stitches are dissolving and do not need removal. Dressings can be removed after 4-5 days.

What are the risks of laparoscopic nephrectomy?

This is a major operation done using minimally invasive techniques. The risks include:

Major bleeding requiring blood transfusion or conversion to open surgery (2%)
Adjacent organ injury (<2%)
General complications of surgery - clots in legs/lungs (DVT and pulmonary embolism), heart attack, pneumonia, stroke
Wound complications – infection, wound breakdown, hernia, numbness of skin, chronic pain

When can I resume normal activities?

Usually you can drive and slowly return to normal activities from 2 weeks. It may however be 4-6 weeks before you can resume all normal activities including work.

Do I need to make changes in my lifestyle/diet with only one kidney?

Generally speaking NO as you will have a normal other kidney that will take up the extra work. You will undergo tests before your surgery to assess your remaining kidney and its function. If there is a possibility of significant kidney failure you would be referred onto a renal physician to assess the risk of needing any further treatment including dialysis.

Do I need further chemotherapy or radiotherapy after surgery if it is a proven to be a kidney cancer?

We will discuss the pathology results with you but usually no other treatments are required unless disease is discovered outside of the kidney.

What will be my follow up after surgery?

Your postoperative review is usually between 2-6 weeks where the pathology results are discussed. You will need follow up scans and blood tests long term and we will detail this once the pathology results are known.