Open Partial Nephrectomy
Before the operation
- You will have a pre-assessment visit where a Nurse will see you and you will have blood tests, a chest x-ray and an ECG.
- You will be admitted to the ward on the day of surgery.
- Mr Anderson will mark your body with an arrow to indicate the correct side for the operation, as well as go through the consent signing process.
- You need to have no food 6 hours before the surgery. You may drink water until 2 hours before the surgery.
- You will wear anti-embolism socks (like very tight stockings) to prevent blood clots forming in your legs.
- The anaesthetist will see you before or on the morning of surgery.
After the operation
- If you are high risk, you will be in the High Dependency Unit for 1 to 2 nights
- You will probably have:
- Oxygen prongs in the nose
- A morphine machine to control your pain
- A wound drain to remove excess blood and fluid
- A catheter to drain your bladder (2 to 3 days)
- You will gradually be allowed to eat and drink, but will only have oral fluids on the day of surgery and soup in the evening.
- You may need laxatives to help you regularly open your bowels.
- It is important that you mobilise out of bed the day after the surgery. Either the physiotherapist or nurses will help you to exercise and to get out of bed.
- Your blood will be tested almost every day (for full blood count and kidney function).
- You will be given a spirometer, which is a machine through which you inhale air to expand the lungs to reduce the risk of chest infection. You need to do this 10 times per hour.
- You will probably be ready to go home 5 to 7 days after the operation.
- Your wound care can be conducted by a District Nurse your GP or at the hospital.
- We shall arrange regular appointments for follow up tests and scans.
- We can provide you with a sickness certificate to cover your time in hospital.
At home
- You will feel tired for about 2 to 3 months.
- Take gentle exercise.
- No heavy lifting such as children or luggage.
- Do not drive for 2 to 4 weeks due to the risk of internal damage if you have to do an emergency stop.
- Keep the wound clean by taking a shower rather than a bath.
- Watch for signs of wound infection such as pain, redness, and swelling and discharge (oozing).
- Watch for any swelling or pain in your abdomen. This can be a sign of a leak of urine from your kidney. If you notice this, contact the ward or Mr Anderson directly.
- Talk to your GP or District Nurse if you have any concerns. You can also contact Mr Anderson directly.
Are there any risks?
This is a common and safe procedure, but every procedure has some risks associated with it. Below is a list of risks for a partial nephrectomy that has been compiled by the British Association of Urological Surgeons:
Common
· Temporary insertion of a bladder catheter and wound drain.
Occasional
· Bleeding requiring further surgery or transfusions.
· Total nephrectomy will be performed if partial is thought to be not possible.
· Entry into lung cavity requiring insertion of temporary drainage tube.
· Need of further therapy for cancer control.
· Infection, pain or bulging of incision site requiring further treatment.
Rare
· Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, deep vein thrombosis, heart attack and death).
· Rarely urinary leak from kidney edge requiring further treatment or stent.
· Involvement or injury to nearby local structures -blood vessels, spleen, liver, lung, pancreas and bowel requiring more extensive surgery.
· The pathology result might show no cancer , but another benign finding .
· Need for further treatment if histology suggests incomplete removal.
Further information on some of the risks involved are detailed below.
- Chest infection may occur. It is extremely important to do deep breathing exercises and cough up any phlegm after the operation. The spirometer should be used to expand the lungs 10 times per hour . If you develop a chest infection, you may require antibiotics and more intensive physiotherapy.
- Bleeding may occur during the operation. If this happens, you might need a blood transfusion which will be done at the same time as the operation.
- Diaphragm Perforation: a small puncture in the diaphragm may occur during the operation. If this happens a chest drain may be required which will help remove fluid from your lungs until the puncture has healed (about 3 days).
- A blood clot may occur in the legs or in the lungs which means you will require medication to keep your blood thin for several weeks or months.
- Paralytic ileus may occur. This is when the bowel becomes distended (swollen) with gas and causes abdominal swelling. The bowel needs to be rested for 24 to 48 hours. You will not be allowed to eat but you will be permitted to drink water. You might have a drip for hydration. This condition invariably settles in 2 to 3 days.
- Bowel injury may occur. A surgical instrument might damage the bowel during the procedure. This is usually noticed at the time and dealt with. It should not cause you any problems.
- Urinary leakage: urine may leak from the repaired area in the kidney into surrounding tissue. The urine collects in the drainage bag if urine is leaking. The drain will need to stay in as long as the leak persists. Sometimes a stent (tube) in the ureter is needed. This siphons the urine down the correct way and the leak eventually seals off .The procedure to place a stent is done under general anaesthetic and takes about 15 minutes.
- Bulging at incision site may occur due to damage to the nerves that usually keep the muscles in that area firm. If this happens, you might need a corset-like support or even further surgery to correct the bulge. This is a complication that unfortunately develops in some people. It is unpredictable as to who might be affected.
Laparoscopic or Robotic Radical or Partial nephrectomy
What is a laparoscopic or Robotic Radical nephrectomy?
It is an operation to remove the whole kidney using keyhole surgery. The surgeon makes 3 to 6 small incisions (cuts), with one longer incision at the end of the operation to remove the kidney.
The information regarding laparoscopic/ robotic Radical nephrectomy is almost the same as that of laparoscopic/robotic Partial nephrectomy: see below. There is one obvious exception – the risk of Urine leak does not happen when the whole kidney is removed.
What is a laparoscopic or Robotic Partial nephrectomy?
It is an operation to remove a cancerous tumour in the kidney and leave behind the remaining normal kidney using keyhole surgery. The surgeon makes 3 to 6 small incisions (cuts). The operation takes approximately 3-4hrs.
Before the operation
- You will have a pre-assessment visit where a Nurse will see you and you will have blood test, a chest x-ray and an ECG.
- You will be admitted to the ward on the day of surgery.
- Mr Anderson will mark your body with an arrow to indicate the correct side for the operation, as well as go through the consent signing process.
- You need to have no food 6 hours before the surgery. You may drink water until 2 hours before the surgery.
- You will wear anti-embolism socks (like very tight stockings) to prevent blood clots forming in your legs.
- The anaesthetist will see you before or on the morning of surgery.
After the operation
- If you are high risk, you will be in the High Dependency Unit for 1 to 2 nights
- You will probably have:
- Oxygen prongs in the nose
- A morphine machine to control your pain
- A wound drain to remove excess blood and fluid
- A catheter to drain your bladder (2 to 3 days)
- You will gradually be allowed to eat and drink, but will only have oral fluids on the day of surgery and soup in the evening.
- You may need laxatives to help you regularly open your bowels.
- It is important that you mobilise out of bed the day after the surgery. Either the physiotherapist or nurses will help you to exercise and to get out of bed.
- Your blood will be tested almost every day (for full blood count and kidney function).
- You will be given a spirometer, which is a machine through which you inhale air to expand the lungs to reduce the risk of chest infection. You need to do this 10 times per hour.
- You will probably be ready to go home 3 to 4 days after the operation.
- Your wound care can be conducted by a District Nurse your GP or at the hospital.
- We shall arrange regular appointments for follow up tests and scans.
- We can provide you with a sickness certificate to cover your time in hospital.
At home
- You will feel tired for about 2 to 3 months.
- Take gentle exercise.
- No heavy lifting such as children or luggage.
- Do not drive for 2 to 4 weeks due to the risk of internal damage if you have to do an emergency stop.
Are there any risks?
This is a common and safe procedure, but every procedure has some risks associated with it. These are related to the anaesthetic and the surgery itself:
Below is a list of risks for a laparoscopic nephrectomy/partial that has been compiled by the British Association of Urological Surgeons:
Common
- Temporary insertion of a bladder catheter and wound drain.
Occasional
- Bleeding requiring further surgery or transfusions.
- Entry into lung cavity requiring insertion of temporary drainage tube.
- Need of further therapy for cancer control.
- Infection, pain or bulging of incision site requiring further treatment.
Rare
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, deep vein thrombosis, heart attack and death).
- Rarely urinary leak from kidney edge requiring further treatment or stent.
- Involvement or injury to nearby local structures -blood vessels, spleen, liver, lung, pancreas and bowel requiring more extensive surgery.
- The pathology result might show no cancer , but another benign finding .
- Need for further treatment if histology suggests incomplete removal.
Further information on some of the risks involved are detailed below:
- Bleeding may occur during the operation. If this happens, you might need a blood transfusion which will be done at the same time as the operation.
- Diaphragm Perforation: a small puncture in the diaphragm may occur during the operation. If this happens a chest drain may be required which will help remove fluid from your lungs until the puncture has healed (about 3 days).
- A blood clot may occur in the legs or in the lungs which means you will require medication to keep your blood thin for several weeks or months. It is very important to get out of bed and move around as soon as possible after the operation.
- Chest infection may occur. It is extremely important to do deep breathing exercises and cough up any phlegm after the operation. The spirometer should be used to expand the lungs 10 times per hour. If you develop a chest infection, you may require antibiotics and more intensive physiotherapy.
- Paralytic Ileus may occur. This is when the bowel becomes distended (swollen) with gas and causes abdominal swelling. The bowel needs to be rested for 24 to 48 hours. You will not be allowed to eat or drink. You will have a drip for hydration. This condition invariably settles in 2 to 3 days.
- Bowel injury may occur. A surgical instrument might damage the bowel during the procedure. This is usually noticed at the time and dealt with. It should not cause you any problems.
- Urinary leakage: urine may leak from the repaired area in the kidney into surrounding tissue. The urine collects in the drainage bag if urine is leaking. The drain will need to stay in as long as the leak persists. Sometimes a stent (tube) in the ureter is needed. This siphons the urine down the correct way and the leak eventually seals off .The procedure to place a stent is done under general anaesthetic and takes about 15 minutes.
- Bulging at incision site may occur due to damage to the nerves that usually keep the muscles in that area firm. If this happens, you might need a corset-like support or even further surgery to correct the bulge. This is a complication that unfortunately develops in some people. It is unpredictable as to who might be affected.
Laparoscopic Cryotherapy
What to Expect
You would be pre-assessed for a general anaesthetic in advance of the procedure which would involve the taking of some blood tests and possibly chest x-ray and ECG, depending on your level of fitness and age. You will arrive on the day of surgery and be seen by the surgeon and anaesthetist.
As mentioned, a minimally invasive technique is used. One method is hand assisted laparoscopy, whereby an incision of a 6-7cm is made through the umbilicus and this will allow the insertion of the surgeons hand to help direct the needle. There will be two 1cm incisions in the flank and possibly a further 1cm incision in the mid-line above the umbilical incision.
Alternatively, pure laparoscopy/robotics might be used. In this case there will merely be 3 or four 1 cm cuts on the skin surface. The procedure takes about three hours and one would expect pain control to be excellent. You might have a rubber tube coming out of one of the small above mentioned holes, which would be there for a day. You will also have a catheter in the bladder which will come out the following morning. Finally, you would have an intravenous line in one of your arms.
It would be expected that you would be discharged on the second morning after the operation. Once home, we would suggest a gradual return to normal activity over a period of about a week. Return to work needs to be decided on the nature of the work and each individual case would be discussed.
In the longer term, you would have CT scans performed to monitor the progress of the kidney and the first would be expected at three months post operatively. In the event of tumour recurrence one would have to re-evaluate the best form of management which might involve a repeat of the same procedure or alternatively a larger undertaking with the removal of the entire kidney if feasible.
Are there any risks?
Common
- Temporary insertion of a bladder catheter and wound drain.
Occasional
- Bleeding requiring further surgery , transfusion or further intervention to stop the bleeding
- Entry into lung cavity requiring insertion of temporary drainage tube.
- Need of further therapy for cancer control.
- Infection, pain or bulging of incision site requiring further treatment.
Rare
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, deep vein thrombosis, heart attack and death).
- Rarely urinary leak from kidney edge requiring further treatment or stent.
- Involvement or injury to nearby local structures -blood vessels, spleen, liver, lung, pancreas and bowel requiring more extensive surgery.
- May be abnormality other than cancer on microscopic analysis.
- One can develop a hernia at the site of one of incisions, this usually takes a long period of time to develop but can be managed surgically at a later date if this is problematic.