Laparoscopic Nephrectomy
Indications
Reasons for removal of a kidney are the presence of cancer, recurrent kidney infections, severe stone disease or long term obstruction of the kidney that causes intractable pain or loss of function.
Conventional open surgery to remove a kidney requires a flank or abdominal incision 8 to 20 inches in length. Moreover, in many instances it is necessary to remove a rib to allow adequate exposure. Most of these procedures may be performed with similar success rates by laparoscopy using small "key hole" incisions.
Procedure
The patient undergoes general anesthesia for this procedure. Four to five small cylindrical tubes called trocars are inserted into the abdominal cavity. The trocars allow entry of a video-telescope, called a laparoscope, that provides a magnified view the entire abdominal cavity and kidney and allows identification of vessels and structures with more clarity than is possible in open surgery. Additional trocars allow the introduction of instruments necessary to perform surgery. With all the trocars and instruments in place, the ureter and the vessels that bring blood to and from the kidney are clipped. The kidney is then freed from all of its surrounding structures and pulled into a bag that has been inserted into the operative area through a trocar. It is removed by enlarging one of the trocar incisions by approximately two inches.
Results
Several investigators, including our group, have compared laparoscopic nephrectomies with standard open nephrectomies in terms of time of surgery, blood loss, pain medication requirements, length of hospital stay, time to return to normal activity and complications. The results show that operating time for laparoscopy is slightly longer, but the amount of pain medication required, time in the hospital and time away from work are significantly shorter for these patients. In addition, the cosmetic results are better for patients treated by laparoscopy. The complication rates and blood loss associated with the two are similar.