Marc Laniado MD FRCS(Urol) FEBU
CONSULTANT IN UROLOGY

1. What is laparoscopy?
2. What are the advantages of a nephrectomy performed laparoscopically?
3. What are the disadvantages of a nephrectomy performed laparoscopically?
4. How is the operation performed?
5. What can I expect after the operation?
6. What are the risks of the operation?

What is laparoscopy?

This is a technique to reach parts of the body without the use of large incisions. Instead, a narrow telescope and instruments are inserted through small incisions allowing surgery to be performed. The intention is to achieve the same results as would be obtained by conventional surgery.

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What are the advantages of a nephrectomy performed laparoscopically?

The advantages are multiple and include the following:

• smaller skin incision - four 1 cm incisions rather than a 30 cm incision
• better view because of the magnification of the system
• less pain because the incisions are smaller and the muscles are parted rather than cut
• 3 to 5 days in hospital compared to a week or longer by open surgery
• less blood loss and reduced need for a blood transfusion
• the ability to return to work in 2 to 4 weeks compared to 6 or more weeks after traditional open surgery

There are no differences in the chance of cancer cure whether the surgery is performed by traditional open means or laparoscopically.

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What are the disadvantages of a nephrectomy performed laparoscopically?

As the hands are not directly in the body, it is less easy to feel what is happening compared to open surgery. In some situations, the tactile feedback can be important and if that becomes true, it would be necessary to make an incision to carry on. Other disadvantages include the increased length of time necessary for the operation, the significantly increased cost of the equipment and the necessity for the surgeon to be experienced in laparoscopy before being able to perform the operation.

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How is the operation performed?

Small incisions are made in the side of the abdomen. Typically, there are about 3 or 4 incisions between 0.5 cm and 2 cm just below the ribs on the side of the problem. The operation lasts for about 2 hours to 3 hours. Through instruments passed through small holes (ports), the kidney is isolated from the rest of the body. At the end of the procedure, an incision is made in the lower abdomen (belly) below the belt line, which is 5 to 7 cm in length, allowing the kidney to be removed from the body. There is usually a tube left inside the body near the site of the operation and this comes out through the skin (‘drain’). This is placed to allow fluid that is produced by the body to be expelled. The tube is removed when fluid stops draining, which is usually after a day or so. The incision sites are stitched. There is a tube (‘catheter’) coming out from the bladder through the urethra (water pipe) and connected to a ‘catheter bag’. This is removed after a day or so.

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What can I expect after the operation?

The drain and catheter are usually removed on the first or second day after surgery. You can usually go home between the second and fourth day of the operation. The stitches or clips in the skin are usually removed after 10 to 14 days. In some situations, the stitches will dissolve spontaneously. Your doctor will advise you.

After 2 to 4 weeks after the operation, it should be possible to return to work. People vary and it depends on the degree of physical activity necessary to be performed and how you feel. You can drive when you are able to brake safely, and this usually takes several weeks.

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What are the risks of the operation?

Every operation has risks. These risks are rare but include the following:

• the need to convert from laparoscopic ('keyhole') to traditional open surgery by making a large skin incision
• significant bleeding that requires a blood transfusion
• a drain that is required for more than a few days possibly due to excess bodily fluid production
• infection of the incision sites, urine, lungs or elsewhere in the body. This would normally need antibiotics alone, but rarely may require additional treatment
• injury to other nearby bodily structures. These include the spleen, bowel, liver, pancreas or large blood vessels. In general, such injuries would require conversion from laparoscopic to open surgery
• recurrent tumour if the operation is performed for cancer
• general risks of all surgery: clots in the leg, stroke, heart attack

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