Benign Kidney Diseases—Laparoscopic Simple Nephrectomy
Numerous benign diseases afflict the kidney which may require its removal. These diseases may include the autosomal dominant polycystic kidney disease Area of specialization button (ADPKD), nonfunctioning kidneys, kidneys causing infections, high blood pressure, pain, and/or bleeding. Once the patient and his/her surgeon decide to have the kidney(s) removed, the urologists at the University Of Chicago Hospitals offer the laparoscopic approach to this procedure. The patient is first placed to sleep. Then he/she is turned onto the side. 4-5 key-hole size incisions are placed on the same side of the body as the kidney to be removed. The surgeon's hands are never inside the patient's body during surgery. Long instruments are inserted through these keyhole incisions. The surgeon watches a television monitor which gives him a view of the abdomen inside. The colon which covers the kidney is first taken down, exposing the kidney. The blood vessels supplying the kidney is identified, isolated and clipped, then cut. The rest of the attachments to the kidney are then dissected until the kidney is completely freed. In most cases, the kidney is removed through one of the keyhole incision that is extended to approximately 2". In cases where a previous kidney infection is known, a drain may be left in from the flank, which is removed before the patient is discharged home. In ADPKD patients, often both kidneys are removed during the same operation. Therefore, the patient is repositioned to face the opposite side, and mirror-image operation is performed to remove the other kidney. A lower abdominal Bikini-line incision is then made of approximately 10-12", depending on the size of the kidney(s), and a hand is used to reach into the abdomen to retrieve the kidneys. The patient is then awakened after the surgery is completed.
The laparoscopic approach has numerous advantages over the conventional open approach. First, the patient will feel less pain postoperatively compared to the open approach. This is in part due to the small keyhole incisions and the single lower incision made. In the open approach, depending on the kidney or kidneys removed, the operation could result in either a 10-12" incisional scar over the flank or a larger 18"-20" incision in the midline of the abdomen. Naturally, larger incisions result in more pain. Another reason for less pain is that less trauma is caused in a laparoscopic case since the surgeon's hands are never inside the patient's abdomen, and large metal retractors for keeping the incision open are not needed. Less pain also means faster postoperative recovery. The patients are typically given regular diet and are ambulating by the first day after surgery. The patients usually stay in the hospital for 2 days, and the patients are back to their normal activities by approximately 4 weeks following surgery. In addition to these advantages, the laparoscopic approach also offers a better cosmetic result due to the small and almost negligible incisional scars over time.