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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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