Laparoscopic Radical Nephrectomy
A radical nephrectomy is a surgical procedure that removes the entire kidney, the surrounding fat including the layer covering the fat (Gerota's fascia), possibly the adrenal gland (an organ sitting on top of the kidney), and occasionally the nearby lymph nodes. This operation can be done through a large incision in the side (open radical nephrectomy), or performed laparoscopically (through several tiny holes in the belly). The laparoscopic technique has become the preferred technique for small to moderately sized tumors (< 7 cm), since there is less pain postoperatively, and it leaves a much smaller scar. For larger tumors, the Nephrectomy can be performed laparoscopically, or by using an open technique. We will commonly start the case laparoscopically for mobilization, and then only convert to an open incision if a safe dissection is not possible using the minimally invasive approach (laparoscopy).
Preoperatively the patient will need to complete a mechanical bowel preparation to clear the bowel contents within the abdomen. This allows us to move the bowel out of the way, as we move into the back of the abdomen to remove the kidney.
A person can live with part of 1 working kidney, so most people are able to return to a normal lifestyle following radical nephrectomy. However, if both kidneys are removed, or not working well, the patient will need dialysis (using a machine that acts like a kidney, to clean the blood), or a kidney transplant (using a healthy kidney, which has been donated by another person).
General Considerations
Patients who are scheduled to undergo a laparoscopic nephrectomy (radical, partial, or simple) will be given preoperative instructions. The most important of these instructions is the preoperative bowel preparation. The purpose of cleaning out the bowels is to provide as much space as possible to work within the abdomen. Another reason for the bowel prep is if an inadvertent bowel injury occurs (< 1% of the time), the bowel prep limits the amount of contamination, and allows us to perform an uncomplicated repair of the bowel. We do not ask patients to donate blood before laparoscopic nephrectomy, since the need for blood transfusions is < 1 %.
For your upcoming surgery, you will be given a form with the date and time of surgery, and the time you should arrive at the George Washington University Hospital. Many patients park at a Metro stop and take the Metro train to Foggy Bottom/GWU, which is located in from of the hospital lobby. Alternatively, there is a parking garage on I Street, less than 1 block from the hospital.
On the day of surgery your surgeon will greet you in the pre-op area and answer any last minute questions that you may have. You will meet the anesthesia team, and several peri-operative nurses. You will also meet our resident house staff, and fellow. These doctors will be involved in your hospital care, and you will most likely see them several times after your surgery has finished. It is a busy time, but your family will be able to stay with you for most of the preoperative time, until you are taken back to the operating room.
Postoperatively you will be given a prescription for pain pills and stool softeners. You may need to use the pain medication for several days, but we encourage you to quickly transition to Tylenol for pain control, and use the narcotic pain medication sparingly.
As with any major operation, there are risks associated with the performance of a laparoscopic or open nephrectomy. The risks of these operations include but are not limited to bleeding, infection, damage to the lung, pleura, liver, spleen, bowel, nerves, major vasculature, and complications related to anesthesia. With a partial nephrectomy there is also a risk of urinary leak, and delayed bleeding. It is important for the patient to realize that after any laparoscopic case that they should feel a little better every day. If you experience a dramatic turn for the worse, such as increasing belly pain, or increasing pain at one of the laparoscopic ports, nausea and vomiting, fevers (> 101 F) and chills, shortness of breath, chest pain, or unilateral leg swelling, the patient should return to the hospital emergency room (ER) right away for re-evaluation. On the other hand, the majority of patients do extremely well, and recover rapidly.
If you have a routine uncomplicated postoperative course, you should call the office to schedule a follow up appointment between 1 and 2 weeks following surgery. During the follow up appointment, we will evaluate how you are doing, exam your wounds, and review your pathology. Please bring your spouse or significant other to this visit.
Following successful surgical removal of the kidney and tumor, the patient will need to be seen periodically by the Urologist to ensure that the tumor does not return. Please refer to the information pages on Kidney Cancer (Renal Cell Carcinoma) for more specific information.