Wellington Urology Associates Wakefield Hospital, the largest private hospital in the Wellington region

 

Laparoscopic Nephrectomy

Having decided that the kidney, or part thereof, is to be removed for donation or as treatment for your kidney problems, there is a choice between open surgery and laparoscopy. Where nephrectomy is for kidney cancer, this information should be read in conjunction with the information on kidney cancer. Partial nephrectomy may be performed laparoscopically in selected situations, allowing preservation of much of the normal kidney for long-term renal function.

Laparoscopy is associated with less pain, fewer problems and superior recovery when compared to the open procedure, allowing earlier return to normal function and fewer long-term complications. It follows the same principles as open surgery and achieves similar results in terms of cure of the underlying condition. A 5cm incision must be made to remove the kidney from within the abdomen, but this can be positioned above the pubis, where it has fewer complications, is readily recovered from and is cosmetically better. In women, the kidney may be removed through the vagina as an alternative to the additional suprapubic incision. The remaining scars are small and cause little problem. However, the technique is more difficult and more expensive, with longer operating times.

The procedure is performed under general anaesthetic. Recovery is generally quick, with a hospital stay of 2-4 days and return to normal activities by 2 weeks.

Illustration here

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur overall in 5% of patients. Early complications are commoner with partial nephrectomy, occurring in <20% of patients. Those recognised as common or serious are listed below but this does not include the rare and extraordinary. From data on fit kidney donors, risk of death is 0.03%. We try at all costs to avoid any adverse outcome.

Early complications -- Failed procedure and conversion to open procedure
<1% Conversion from partial to total nephrectomy.
  Urine leak requiring stent and drainage: <10% of patients post partial nephrectomy.
Bleeding: - Requiring blood transfusion: <1% total, <10% partial nephrectomies.
 Requiring embolization: < 5% of partial nephrectomies.
 
 Damage to other organs, including injury to the sympathetic nerve trunk with retrograde ejaculation < 0.1% (usually temporary but if persistent may compromise later fertility).
 Infection. Shoulder pain, temporary numbness, tingling. DVT, PE, gas embolism.
Late complications -- Adhesions.
 Port site hernia and port site tumour recurrence have occurred with laparoscopy for kidney cancers.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.