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  Laparoscopic Nephrectomy (Removal of the Kidney)
 

What are the indications for surgical removal of a kidney?

Common indications for removal of a kidney include kidney tumor, chronic kidney infection, non-functioning/infected kidney, and non-functioning kidney with large stones. Less common indications are non-functioning kidney due to chronic obstruction (hydronephrotic kidneys), hypertension due to renovascular disease, and large cysts of the kidney causing painful symptoms.

When was the first laparoscopic nephrectomy performed? What are its results?

The first laparoscopic nephrectomy was performed in 1990. Since that time, this procedure has been an accepted method to remove the kidney for both benign and malignant diseases of the kidney. General acceptance of this approach has been supported by solid data demonstrating equal efficacy in curing patients with kidney cancer when compared to traditional open surgery. What has been most impressive is its significant impact on the healing process and recovery. Potential complications include those that may be encountered in traditional open surgery, such as bleeding, infection, and injury to adjacent organs. In rare occasions (<5%), the procedure is unable to be completed laparoscopically and a larger incision is made to remove the kidney.

Is there any special preparation for the patients?

Preparation for laparoscopic surgery is no different from that of open surgery, requiring only a gentle bowel prep using a mild oral laxative.

What is the basic method?

In these operations, we typically use a transperitoneal approach (through the abdominal cavity) using 4 keyholes or ports. After the kidney has been completely detached, it is placed into a plastic bag and removed from the body.

What are the advantages over open surgery?

Most patients resume a diet the night of surgery or the morning after surgery, and are able to go home the next day or within 48 hours. Advantages of removing the kidney by this method include reduced blood loss, minimal pain after the operation, little scarring from the small incisions, and most impressively, quicker return to regular activity.

We anticipate future use of laparoscopy to remove
only the portion of the kidney containing the cancerous tumor (partial nephrectomy). This is especially important in patients with marginal kidney function in whom preservation of normal kidney is critically important.

Are there other ways kidney tumors can be surgically treated?

There has also been increasing interest in treating kidney tumors
without having to remove all, or even part, of the kidney (ablation of kidney lesions or destruction of kidney lesions). There are several circumstances when this approach is advantageous. First, many of the kidney tumors found today are incidental findings and can be quite small. Excising all or part of the kidney may not be necessary in selected patients. In addition, certain groups of patients are prone to have tumors affecting both kidneys. Again, in these patients, we would try to preserve as much normal kidney as possible. Lastly, destruction or ablation of kidney tumors may be desirable in patients who cannot endure or tolerate a longer, more complicated operation.

Is there still a role for open kidney cancer surgery?

Yes. Very large or complex tumors are still being removed by open surgical methods. These tumors may be locally invasive and may have tumor tissue (tumor thrombus) within the major vein draining the kidney.


*  This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information.

 

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