Laparoscopic Surgery

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Kidney Cancer - Laparoscopic Nephrectomy, Partial Nephrectomy , Cryoablation and Nephroureterectomy

Kidney Cancer - Laparoscopic Nephrectomy, Partial Nephrectomy , Cryoablation and Nephroureterectomy

 

Kidney

Kidney tumors can present in various sizes and locations on the kidney. The patient and his/her physician must decide what kind of approach and how much of the kidney to remove with the tumor. There are three types of laparoscopic treatment of cancerous kidney tumor: laparoscopic radical nephrectomy where the entire tumor bearing kidney with the surrounding fat and envelopes is removed, laparoscopic partial nephrectomy, where the tumor is cut out of the kidney with a margin of normal tissue around it, and laparoscopic cryoablation of renal tumor, where the tumor is frozen and thawed twice to get complete tumor destruction within the kidney. Finally, for urothelial carcinoma, or transitional cell carcinoma of the kidney, we offer the laparoscopic radical nephroureterectomy, where the kidney, the ureter, and part of the bladder are removed.

 

Laparoscopic Radical Nephrectomy
After the patient is asleep, he/she is then turned onto the side. 4-5 keyhole size incisions are made on the same side of the body as the kidney tumor. The surgeon’s hands are not inside the patient’s body during surgery. Long instruments are inserted through these keyhole incisions. The surgeon watches inside of the abdomen on a television monitor. The blood vessels of the kidney and the ureter (the tube that drains the kidney to the bladder) are exposed, clipped and cut, and the kidney is released off all attachments. It is then placed into a bag, and pulled out through one of the incisions. This incision is extended to approximately 3-5”, depending on the size of the kidney and tumor. After the operation, the patient will feel much less pain compare to the conventional open surgery. This is mainly due to the small incisions made, but also, no large metal retractors are needed to keep the incision open, which contributes to less pain. Blood loss is almost always minimal; therefore patients will not likely require blood transfusion. Less pain translates to earlier recovery. The patient is given regular diet by the first day after surgery, and is encouraged to get out of bed and walk. Most patients stay in the hospital for 1-2 days, and usually are back to work within one month. This is in contrast to the open procedure, which the patients typically have an incisional scar of 7”-10”, and are hospitalized for 4-5 days, with a recovery time of approximately 6-12 weeks.

 

Laparoscopic partial nephrectomy
After the patient is asleep, depending on the location and size of the tumor, the surgeon may need to place a plastic tube (ureteral stent) into the kidney prior to removing the tumor. The stent is inserted by using a scope through the bladder and is a short procedure which takes approximately 20 minutes. Irrigating this tube will allow the surgeon to see if there is leakage of urine after the tumor is excised from the kidney. The patient is then placed on his/her side on the operating table, and 4-5 keyhole incisions are made on the skin. Long instruments are inserted into the incisions, and the operation is performed through these keyhole incisions. The surgeon watches the inside of the abdomen on a television monitor. The kidney and tumor are exposed, and the artery and vein feeding the kidney are isolated. A clamp is placed across the kidney artery to prevent bleeding. The tumor is cut from the kidney with a rim of normal tissue. After the tumor is removed from the kidney, blue dye is injected into the stent which was previously inserted. The blue dye will allow the surgeon to see areas that need to be repaired to prevent urine leakage. The tumor defect on the kidney is closed with sutures. The clamp on the artery is then released. After the surgeon makes sure that there is no bleeding, the tumor is placed in a bag and removed from one of the incisions. A renal drain is left for 24-48 hours.

 

After the procedure, the patient will feel less pain compared to the open partial nephrectomy. This is, in part, due to the small keyhole incisions made; compared to an open partial nephrectomy, where a 7-10” incisional scar is made. Further, no large metal retractors for keeping the incision open are necessary, thus contributing to less pain. Less pain also means faster recovery. The patients are typically given regular diet and are walking around by the first day after surgery. Hospitalization is usually 2 days following surgery, and the patients are back to their normal activities by approximately 4 weeks following surgery.

 

Laparoscopic Cryoablation of Renal Tumor
In laparoscopic cryoablation of the renal tumor, the cancerous renal tumor is frozen and thawed two times until the tumor cells are killed. The initial approach is the same as laparoscopic radical or partial nephrectomy. The patient is placed to sleep. He/she is then turned onto the side. 4-5 keyhole size incisions are placed on the same side of the body as the kidney tumor. The surgeon’s hands are not inside the patient’s body during surgery. A video camera and long instruments are inserted through these keyhole incisions. The surgeon watches a television monitor which gives him a view of the inside of the abdomen. The kidney is then exposed, and the tumor is identified. The fat surrounding the tumor is removed, revealing the extent of the tumor. Laparoscopic ultrasound imaging of the tumor is performed if necessary. A cryoablation probe is used to puncture and advance into the center of the renal tumor. The tumor is then frozen and thawed for two cycles to ensure that tumor cells are killed. At the end of the cycles, the probe is removed, and the surgery is completed. Postoperatively, the patient will feel minimal pain. This is in part due to the small incisions made. Also, no large metal retractors are needed to keep the incision open, which contributes to less pain. Blood loss is almost always minimal; therefore patients will not likely require blood transfusion. Less pain translates to earlier recovery. The patient is given regular diet and is walking around by the first day after surgery. Most patients stay in the hospital for 1-2 days, and usually are back to work in less than one month.

 

Laparoscopic Radical Nephroureterctomy
In laparoscopic radical nephroureterectomy, the initial approach is the same as laparoscopic radical or partial nephrectomy. 4-5 keyhole size incisions are placed on the same side of the body as the kidney tumor. The surgeon’s hands are not inside the patient’s body during surgery. A video camera and long instruments are inserted through these keyhole incisions. The surgeon watches a television monitor which gives him a view of the inside of the abdomen. The kidney is freed from all attachments. Then, the ureter is also freed and dissected down to the area of the bladder. The laparoscopic portion of the surgery ends here. A 4-5” incision is made on the lower part of the abdomen, and the bladder is opened. The ureter that is attached to the affected kidney is dissected from below until the entire ureter is freed. The kidney, ureter, and part of the bladder attached to the ureter are then all removed together. The bladder and the incisions are closed. Postoperatively, the patient will feel less pain. This is in part due to the smaller incisions made. In contrast to the open procedure, patients often end up with a large 1’ abdominal incision or two 6” incisions. In the laparoscopic approach, blood loss is almost always minimal; therefore patients will not likely require blood transfusion. Less pain translates to earlier recovery. The patient is given regular diet and is walking around by the first day after surgery. Most patients stay in the hospital for 3-4 days, and usually are back to work in about one month.