Laparoscopic Partial Nephrectomy

Laparoscopic Partial Nephrectomy

What is Laparoscopic Partial Nephrectomy?

Laparoscopic partial nephrectomy is a minimally invasive technique used to remove a small kidney tumor while preserving the rest of the kidney. Compared to traditional open surgery, this method provides patients with less discomfort and equivalent outcomes.

When compared to the conventional open surgical technique, laparoscopic partial nephrectomy results in significantly less postoperative pain, a shorter hospital stay, earlier return to work and daily activities, more favorable cosmetic results, and similar outcomes to open surgery. Partial nephrectomy has become a standard procedure for selected patients with renal cell carcinoma (especially those with small (less than four cm) peripherally located tumors). The outcomes of partial nephrectomy are less satisfactory in patients with larger renal cell carcinomas, and radical nephrectomy (removal of the entire kidney) remains the standard approach.

The Surgery

Laparoscopic partial nephrectomy is performed under general anesthesia. The typical length of the operation is three to four hours. The surgery is carried out through four small (one cm) incisions made in the abdominal area. Through these keyhole incisions, a telescope and small instruments are inserted into the abdomen, allowing the surgeon to completely release and dissect the tumor without having to place their hands inside the abdomen. The defect in the kidney is then closed with stitches and a special sealing compound. The tumor is then placed inside a plastic bag and removed intact through an extension of one of the existing incision sites.

Potential Risks and Complications

While this procedure has been proven to be very safe, there are risks and potential complications associated with any surgical procedure. The safety and complication rates are similar to those of open surgery. Potential risks include:

• Bleeding: Blood loss during this procedure is typically small, and less than five percent of patients require a transfusion. If you are interested in autologous blood transfusion (donating your own blood) before your surgery, you should inform your surgeon. When you receive your information packet about your surgery, you will receive an authorization form to take to your local Red Cross.

• Infection: All patients are treated with intravenous antibiotics before surgery to reduce the likelihood of infection. If you develop any signs or symptoms of infection after surgery (fever, drainage from your incision, urinary frequency or discomfort, pain, or anything else that concerns you), please contact us immediately.

• Tissue/Organ Injury: Although uncommon, there can be potential injuries to surrounding tissues and organs, such as the bowel, vascular structures, spleen, liver, pancreas, and gallbladder, which may require further surgery. Scar tissue may also form in the kidneys, requiring additional surgery. Injuries to nerves or muscles related to positioning can occur.

• Hernia: Hernias at the incision sites are rare, as all keyhole incisions are carefully closed at the completion of the surgery.

• Conversion to Open Surgery: If difficulties are encountered during the laparoscopic procedure, the surgical procedure may need to be converted to a standard open operation. This could result in a larger open incision than usual and potentially a longer recovery period.

• Urine Leakage: If the urine collecting system of the kidney needs to be cut to remove the kidney tumor, it is typically sutured closed. If urine leaks from this hole, you may need to have an internal drainage tube (stent) to close the leak. Rarely, additional surgery may be required.