Laparoscopic radical nephrectomy requires that patients undergo a general anesthesia. While operative time varies from one individual to another, the average operating time is approximately 3-4 hours.
During laparoscopic radical nephrectomy, approximately 3 to 4 small keyhole (< 1cm) incisions are made in the abdomen, which allow the surgeon to insert a telescope (called laparoscope) and hand-held surgical instruments into the abdomen through portals called trocars.
The laparoscope allows for 10X magnification of the operative field, allowing the surgeon to accomplish the surgical procedure with improved visualization and without placing his hands into the abdominal cavity. The abdomen is filled with carbon dioxide gas to create a larger working space for the surgeon to accomplish the operation. This gas is later evacuated from the abdomen at the conclusion of the operation. The affected kidney is then dissected and exposed from surrounding organs such as the liver, spleen and intestines.
The blood supply to the kidney is clipped and divided, allowing for safe and efficient removal of the kidney with minimal blood loss. The tumor within the kidney and surrounding fat and visible surrounding lymph nodes are removed. The adjacent adrenal gland may also at times be removed if the tumor is large or in close proximity to it. Once the tumor and kidney are excised, they are immediately placed within a plastic sack and the specimens are removed from the abdomen intact by extraction through an extension of one of the pre-existing abdominal incisions. Finally, the skin incisions are closed using plastic surgery techniques to minimize scarring.
Potential Risks and Complications
As with any major surgery, complications, although rare, may occur with laparoscopic radical nephrectomy. Potential risks and complications with this operation include, but are not limited to, the following:
- Bleeding: Blood loss during this procedure is typically less than 100 cc with the rare need for a blood transfusion (<2% of patients). If you are interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. This can be arranged locally in Gainesville, FL at the Civitan Regional Blood center or at your local Red Cross.
- Infection: Although patients are given broad spectrum intravenous antibiotics immediately prior to surgery, infections of the urinary tract and skin incisions may still occur, but are rare. If you develop any signs or symptoms of infection after the surgery (fever, drainage from or redness around your incisions, urinary frequency/discomfort, and/or pain) please contact us immediately.
- Adjacent Tissue/Organ Injury: Although uncommon, adjacent organs and tissues may be injured as a result of your surgery. This includes the colon, bowel, vascular structures, nerves, muscles, spleen, liver, pancreas and gallbladder. If injury to your lung cavity occurs, a small chest tube may be required to evacuate air, blood, and fluid from around your lung, thus allowing your lung to expand and work properly. On rare occasions, further surgery may be required to address unexpected injuries to adjacent organs.
- Incisional Hernia: Because of the small laparoscopic incisions, hernias at these sites occur rarely. In addition, larger incisions are closed carefully prior to the completion of your surgery to minimize the risk of hernias.
- Conversion to Open Surgery: In the rare event of complications or due to difficulty in dissecting by means of laparoscopy, conversion to open surgery is sometimes required. This could result in a larger standard open incision and possibly a longer recuperation period.