Laparoscopic partial nephrectomy
How is it done, and what to expect?
To remove the tumour from kidney laparoscopically , we make very small incisions in the abdomen.
Theses incisions vary between 5 mm up to 12 mm. We go through these incisions with long instruments and we start our surgery.
The surgery has several steps:
1- We start by moving the colon that is usually sitting on top of the kidney
2- We then start dissecting the kidney and the ureter.
3- We identify the blood vessels to the kidney (usually one artery and one vein). There are variations in 40% of the patients.
4- We identify the area of the tumour and we make sure it is properly corresponding to the lesion in the scan
5- We clamp the artery and the vein and we start our timer
6- We dissect the tumour from the kidney
7- We repair the kidney by closing the area where the tumour was by suturing
8- Once we are happy with the closure, we remove the clamps and check for bleeding.
9- If there is still bleeding, we place more sutures till we have proper control
10- We put the lesion in a bag and we then extend one of the incisions to remove the bag.
What are the possible complications:
1- Infection
2- Bleeding
3- Bowel injury
4- Vessel injury
5- Conversion to open
6- Leak of urine
7- Delayed bleeding ( Pseudo aneurysm)
8- Anesthesia risks
9- Ileus (lazy bowels)
10- Diaphragmatic injury
What to expect in the hospital on day of surgery:
1- You will meet the nursing, anesthesia, and surgical team
2- The different teams will go through the process with you multiple times
3- You will be taken to the operating room and you will hear the teams confirming the surgery and the side multiple times
4- The anesthesiologist will put you sleep
5- You will wake up from anesthesia feeling drowsy and sometimes with a sore throat
6- You might have some pain from the small incisions which we can control with pain medications
7- You will be drinking and eating from the first night
8- You will have a foley catheter in your bladder.
9- You will have a drain coming out from one of the incisions
9- You will be expected to sit on the edge of the bed the first night in your room
What to expect on the day after surgery:
1- You will have the foley catheter and the drain removed in the morning
2- You will start walking as much as you can.
3- You lay in bed only to sleep, otherwise, you should sit on the bed or in your chair and keep moving
4- Blood samples will be taken from you in the morning
5- Dr. Shahrour would see you in the afternoon
6- You will be discharged home in the evening
7- If you are from out of town, you should stay in a hotel till next day.
8- You will have follow up with Dr. Shahrour in 4 weeks
9- You will have blood work to be done 2 weeks after surgery
10- Nurses will help you at home with dressing changes and staple removal ( at 2 weeks mark)