Laparoscopic Nephrectomy is a safe & effective procedure designed to remove diseased or cancerous kidneys. This is a minimally invasive technique which provides less discomfort alongside delivering equivalent results when compared to the large incision required by the traditional open surgery. Laparoscopic nephrectomy has also resulted in significantly less postoperative pain, shorter hospital stays, early return to daily activities & work, favorable cosmetic results & outcomes which are identical to that of open nephrectomy.
Initial Appointment for Laparoscopic Nephrectomy
Surgeons will review patients medical history including records, outside reports like past x-rays, CT scans, sonogram & MRI during initial consultation. Brief physical examination may also be conducted during this visit. In case surgeons determine that patient as a good candidate for laparoscopic nephrectomy, a date & time may also be finalized for operation during initial consultation. Therefore, it is quite important that patients gather & bring along all relevant medical information including x-ray films, PSA values, pathology reports & glass pathology slides during initial appointment with the surgeon. Once the surgical date is secured, patients will have to undergo the following tests prior to surgery.
- Physical Examination
- CBC – Complete Blood Count
- EKG – Electrocardiogram
- Comprehensive Metabolic Panel – blood chemistry profile
- PT / PTT – Blood Coagulation Profile
Preparing for Laparoscopic Nephrectomy
Laparoscopic Nephrectomy patients will need to take the following steps prior to undergoing surgery.
- Medications to be avoided prior to surgery – Medications like Aspirin, Alka Seltzer, Advil, Ibuprofen, Motrin, Plavix, Vioxx, Voltaren, Celebrex, Lovenox, Coumadin, Ticlid, Vitamin E & some other medications for arthritis should be avoided at least one week prior to the date of surgery as they can cause bleeding. Patients should also however check with the surgeon in case they are unsure about the medications which should be stopped prior to surgery. They should also make sure to contact the prescribing doctor & get their approval before stopping any medications.
- Clear Liquid Diet & Bowel Preparation – Patients should not eat or drink anything after midnight on the night before surgery. They should however consume one bottle of Magnesium Citrate, which can be purchased from the local pharmacy, on the evening before the date of surgery. Patients should also drink only clear fluids for a period of 24 hours prior to date of surgery. Clear liquids are drinks which allow us to see through.
Clear Liquid Diet for Laparoscopic Nephrectomy Patients
Patients should remember that they are not supposed to eat or drink anything after midnight on the evening before the date of surgery. It would also be ideal to follow the diet plan mentioned below.
- Clear Broths without any noodles, meat, cream soups etc.
- Juices excluding tomato juice or orange juice
- Hawaiian Punch
- Cranberry Juice
- Grape Juice
- Apple Cider or Apple Juice
- Gator Aid
- Kool Aid
- Tea without cream or milk (sweetener may be added)
- Coffee without cream or milk (sweetener may be added)
- Italian Ices or Snowball without marshmallow
- Popsicles without cream or fruit
- Clear Hello without fruit
Laparoscopic Nephrectomy Surgery Procedure
Laparoscopic Nephrectomy surgery is typically performed under general anesthesia. The entire length of operation will last anywhere between 3 – 4 hours of time. This surgical procedure is performed through 3 small incisions which are made within the abdomen. Small instruments & a telescope are inserted through these keyhole incisions into the abdomen. These incisions & instruments allow surgeons requisite access to dissect the kidney without having to place their hands into the abdomen. Dissected kidney is then placed within a plastic sack & is removed intact through an extension of an existing incision site.
Immediately after Laparoscopic Nephrectomy Surgery
Patients will be taken to the recovery room immediately after laparoscopic nephrectomy surgery for monitoring. After some time they will be shifted to the hospital room when they are fully awake & with stable vital signs.
- Urinary Catheter – Patients can expect to have a urinary catheter draining the bladder & which is placed while they were asleep in the operating room. This will stay in place for approximately one day after surgery. Moreover, it is common to have blood-tinged urine for a day or two following laparoscopic nephrectomy surgery.
- Nausea – Quite a few patients experience some amount of nausea which is generally related to anesthesia. However, medications are prescribed for treating nausea in case it is persistent.
- Postoperative Pain – Pain medications can effectively control this postoperative symptom & is commonly delivered to patients through an epidural or intravenous catheter or through a pain shot injection which is administered by the nursing team. However, patients normally experience some minor transient shoulder pain for 1 – 2 days & which is related to usage of carbon dioxide gas which is usually used to inflate abdomen during laparoscopic nephrectomy procedure.
- Fatigue – This is a common condition following laparoscopic nephrectomy & should normally subside on its own within a few weeks time.
- Diet – Patients undergoing laparoscopic nephrectomy can expect to have an intravenous catheter (IV) in place for 1 – 2 days of time. This small tube placed in the patient’s vein will ensure that they receive necessary fluids in order to keep well hydrated. This IV catheter will also ensure that they conveniently receive medication. Moreover, most patients are able to tolerate ice chips & small sips of liquids right from the day of surgery. They can also take regular foods from the next day. Pain medication can be taken by mouth instead of shots or IV once patients are on regular diet.
- Incentive Spirometry – Laparoscopic nephrectomy patients are expected to do some simple breathing exercises in order to help prevent respiratory infections by using an incentive spirometry device. These exercises are also normally explained to patients by the nursing team during their stay at the hospital. Deep breathing & coughing are important parts of recuperation & will help prevent pneumonia & other associated pulmonary complications in laparoscopic nephrectomy patients.
- Ambulation – It is very important that patients get out of bed & begin walking on the day of surgery with help of a nurse or family member so as to help prevent formation of blood clots in legs. Laparoscopic nephrectomy patients can also use sequential compression devices (SCD) along with tight white stockings in order to prevent blood clot formation in legs.
- Constipation / Gas Cramps – Some patients may experience sluggish bowels for several days following laparoscopic nephrectomy surgery resulting from anesthesia administration during surgery. Stool softeners & suppositories are usually given in such cases to help with the problem. Taking a teaspoon of mineral oil will also help prevent constipation. Patients are also discouraged to use narcotic based pain medications as these can cause constipation.
- Hospital Stay – Most laparoscopic nephrectomy patients approximately stay for about 2 days of time following operation.
Recovery Following Laparoscopic Nephrectomy Surgery
Laparoscopic nephrectomy patients are expected to take the following steps at home after discharge from hospital.
- Pain Control – Laparoscopic nephrectomy patients may expect to have some discomfort at home in incision sites which may sometimes require pain medication for few days after discharge.
- Showering – Patients can shower after returning home from the hospital. Wounds should be immediately padded dry after showering as incision sites would invariably get wet after showering. Tub baths are not recommended & therefore should be avoided for the first 2 weeks following surgery as they will soak incisions & increase risk of infection. Patients can also use adhesive strips across incisions & which will fall off within 5 – 7 days on their own. Sutures underneath skin will also dissolve within 4 – 6 weeks of time.
- Diet – Patients should take on a no added salt diet & avoid high protein diets as both of these can cause potential damage to the remaining kidney. It would be best that patients discuss methods & guidelines with the primary doctor after full recovery from surgery.
- Activity – Taking walks for activity is highly recommended. Lying in bed or prolonged sitting must be avoided. Climbing stairs is good if possible, but should be undertaken slowly & carefully. Driving should however be avoided for at least 1 – 2 weeks of time after surgery. Heavy lifting which is greater than 20 pounds should be completely avoided & also exercises like biking, treadmill, swimming & jogging for at least 6 weeks or as instructed by the surgeon. However, most patients return to full home-based activity on an average of 3 weeks & can also return to routine work within 4 weeks of time following laparoscopic nephrectomy surgery.
- Follow-Up Appointment – Attend the follow-up appointment as scheduled & instructed by the operating surgeon.
- Kidney / Liver Function Blood Tests & X-Rays – Nephrectomy patients are typically encouraged to undergo annual blood tests including serum Creatinine so as to follow function of the remaining kidney. Liver function tests are also recommended. Surgeons will normally review these results during follow-up visits to the hospital. Follow-up tests like x-rays, sonograms, MRI & CT are recommended periodically for patients with kidney tumors so as to track appearance of the remaining kidney.
- Pathology Results – Pathological results from nephrectomy surgery are usually available within one week after surgery. These results may be discussed with the surgeon either on phone or during the follow-up appointment at the hospital.
Risks & Complications of Laparoscopic Nephrectomy
Even though laparoscopic nephrectomy has proven to be absolutely safe, there are certain risks & potential complications associated with any type of surgical intervention. Safety & complications rates are also similar for laparoscopic procedure when compared to open surgery. Potential risks associated with laparoscopic nephrectomy include the following.
- Infection – Invariably, all patients are treated with intravenous administration of antibiotics at the beginning of surgery in order to decrease chances of infection liable to occur after surgery. Patients should immediately contact the surgeon in case they develop signs & symptoms of infection after surgery including pain, discomfort, urinary frequency, fever & drainage from incisions or any other concern.
- Bleeding – Blood loss through this laparoscopic procedure is typically minor & blood transfusion is needed only in less than 5% of patients undergoing laparoscopic nephrectomy. Autologous blood transfusion is also an ideal option which patients can make prior to surgery.
- Hernia – Hernias at the site of incisions rarely occur when all keyhole incisions are carefully closed at the completion of laparoscopic nephrectomy surgery.
- Tissue/Organ Injury – Although this is uncommon, it is possible that surrounding tissues & organs including gallbladder, pancreas, liver, spleen, vascular structures & bowel may get injured & therefore will require further surgical intervention. Injuries could also occur to muscles or nerves related to positioning.
- Conversion to Open Surgery – Laparoscopic nephrectomy surgical procedure may sometimes require conversion to standard open operation in case difficulty is encountered during the operation. This would eventually result in a large standard open incision & possibly a longer period for recuperation.
Laparoscopic Nephrectomy Vs Open Nephrectomy Surgery
Patients with kidney cancer need to remove their kidney as treatment. Patients suffering from recurrent kidney infections like long term obstruction of kidney or severe stone disease may develop intractable pain or lose function of the affected kidney & which will warrant nephrectomy surgery. While standard open nephrectomy surgical procedure involves 8 – 20 inches of incision in length, laparoscopic procedure requiring 2 – 3 minute keyholes may be an ideal alternative. Moreover, traditional open surgery has allowed many instances where a rib had to be removed so as to allow adequate exposure; laparoscopic approach at the same time has proved effective with similar success rates.
Affordable Laparoscopic Nephrectomy Surgery in India
With an excellent healthcare infrastructure comprising of top doctors & surgeons alongside internationally accredited hospitals, India has fast emerged as a leading medical tourism destination in the world providing affordable healthcare solutions to international patients. Surgeons in India are well experienced & globally renowned. They are also well aware of the developing trends & expert in handling latest technologies. IndianMedTrip is one of the fastest growing healthcare tourism companies in South Asia offering a wide spectrum of low cost medical treatments including laparoscopic nephrectomy surgery to people from all around the world. IndianMedTrip services which begin with the first telephonic conversation are seamless, hassle-free & extremely convenient so as to end up in a successful outcome.