OVERVIEW

A nephrectomy is the surgery to remove the kidney and can be performed openly or laparoscopically. Radical nephrectomy is indicated in kidney cancer.

 

The reasons for performing a radical nephrectomy are:

  • Kidney cancer in a kidney without function
  • Kidney cancer that replaces most normal kidney tissue
  • Kidney cancer with the presence of a renal thrombus in the renal vein
  • Difficulty performing a partial nephrectomy because the tumor is in the center of the kidney
  • Advanced kidney cancer to reduce tumor burden

Benefits of laparoscopic radical nephrectomy

By completely removing the kidney with cancer and the tissue around the kidney, it is possible to control the disease, this means that many patients with only radical nephrectomy will already have a remission of cancer, even in these cases, the follow-up after of surgery is very important to detect recurrences.

When performed by laparoscopy, radical nephrectomy is a surgery that offers rapid recovery and little postoperative pain.

Risks and complications

The possible complications that may occur when performing a radical nephrectomy are the same that can occur in general with any surgical procedure and these are: hemorrhage, damage to nearby organs, reactions to anesthesia, etc. However, these complications occur infrequently and can be resolved mostly during the same surgery.

The risk of conversion to open surgery is low, (<5%), this may be due to difficulty in the dissection or removal of the kidney and is done to maintain patient safety.

Most people can live with only one kidney, however, sometimes the patient may require replacement therapy of renal function (peritoneal dialysis, hemodialysis, kidney transplant) temporarily or permanently, joint management with a nephrologist for this purpose is suggested.

Alternatives to radical nephrectomy

If the renal tumor is small (less than 4 cm) and is in the periphery of the kidney, a partial nephrectomy may be performed, in which only the tumor is removed to preserve part of the renal function.

In patients with renal cancer who are very weak, it is preferable to provide palliative treatment (remove pain, hydration, etc.) since they could be weakened when subjected to an operation.

What to expect from laparoscopic radical nephrectomy?

Day of surgery:

The day of the operation will arrive in the morning to the hospital in fasting.

The surgery lasts approximately 3 – 5 hours, however, the time is variable.

Anesthesia for this procedure is general, so you will be unconscious during surgery.

Pain after laparoscopic radical nephrectomy is minimal and can be effectively controlled with intravenous analgesics.

Food: on the day of surgery you can eat in the afternoon, there are no food restrictions, however, a balanced diet is recommended.

Physical activity: the day after surgery you can walk. It is expected to feel a bit fatigued after any surgery, this problem resolves spontaneously within a few weeks after laparoscopic radical nephrectomy.

Hospital stay: most patients undergoing radical laparoscopic nephrectomy remain hospitalized for 2 to 3 days.

Wounds: Laparoscopic radical nephrectomy requires 3 small incisions in the abdomen (each 1 cm or less); the kidney is removed through a 10 cm incision in the inguinal region or in the bikini line; once they heal completely, these scars can rarely be seen

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