What does the procedure involve?
This involves removal of part of the kidney with the surrounding fat for suspected cancer of the kidney, through several keyhole incisions. It involves the placement of a telescope and operating instruments into your abdominal cavity using 3-5 small incisions. One incision will need to be enlarged to remove the kidney
What are the alternatives to this procedure?
Observation, total nephrectomy, and open surgery
What should I expect before the procedure?
You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which will include the Consultant and Specialist Registrar, and your named nurse.You will need to wear anti-thrombosis stockings during your hospital stay; these help prevent blood clots forming in the veins of your legs during and after surgery.
What happens during the procedure?
Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. A bladder catheter is normally inserted during the operation to monitor urine output and a drainage tube is usually placed through the skin into the bed of the kidney.
What happens immediately after the procedure?
You will be given fluids to drink from an early stage after the operation and you will be encouraged to mobilise early to prevent blood clots in the veins of your legs. The wound drain will need to remain in place for up to 1 week in case urine leaks from the cut surface of the kidney. The average hospital stay is 4 days.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
Up to 10% patients will develop a urinary leak from the cut edge of the kidney which will require further treatment, usually with insertion of a ureteric stent. Some patients develop bleeding and may require a blood transfusion. In some cases a procedure (called embolisation) in the X-ray department may be required to stop any bleeding. Sometimes, the histological abnormality (as checked under a microscope) may eventually turn out not to be cancer.
What should I expect when I get home?
Before you leave hospital, the team will ensure you are safe to be discharged home. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers. All the wounds are closed with absorbable stitches which do not require removal. It will take at least 14 days to recover fully from the procedure and most people can return to normal activities after 2-6 weeks. If a ureteric stent has been inserted, you may notice that you pass urine more frequently with pain in the bladder region.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, increasing abdominal pain or dizziness, please contact your GP immediately. Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.
Are there any other important points?
A follow-up outpatient appointment will normally be arranged for you 6-12 weeks after the operation. At this time, we will be able to inform you of the results of pathology tests on the removed section of the kidney. It will be at least 14-21 days before the pathology results on your kidney are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion. If a ureteric stent has been inserted, arrangements will be made for its removal approximately 6 weeks after your discharge from hospital.
