The commonest reason for a kidney to be removed (nephrectomy) is cancer, followed by severe damage due to infection or obstruction. In the published medical literature the cure rate from cancer is identical whether the kidney is removed by traditional or laparoscopic means. The benefit of laparoscopy is that it avoids the painful incision that results in a longer hospital stay and recovery time.
Laparoscopy is commonly known as "keyhole surgery”, however although the incisions are small the view is not. Modern equipment produces a wide, bright, clear and magnified view of the operation, often superior to the traditional open approach. In addition, the gas used to distend the abdomen during laparoscopy also greatly reduces bleeding during surgery.
Traditionally the surgical approach to the kidneys requires a 20-25cm incision because the kidneys lie high in the abdomen, beneath the ribs. The laparoscopic operation is performed through 4 x 5-10 mm cuts below the ribs on the side of the abdomen. The kidney is dissected out lying within it's envelope of fatty tissue. Blood vessels taking blood to and from the kidney come out to it from the man midline blood vessels and are carefully identified, clipped and divided. The kidney is then removed in a specifically designed bag to prevent any spillages. One of the port sites may be enlarged to allow removal of the specimen. Rarely technical difficulties may make the operation unable to be completed laparoscopically, if this eventuates conversion to the open procedure may be achieved without difficulty. The likelihood of this happening is less than 5%.
Thousands of cases of laparoscopic kidney surgery have been performed around the world since 1991. The medical literature suggests that it is just as effective as open surgery for both cancerous and non-cancerous reasons but avoids the painful incision that results in a longer hospital stay and recovery time.
This operation is performed for cancer of the ureter and requires removal of the ureter as well as the kidney. Most of the operation is performed in a similar fashion to laparoscopic nephrectomy. The main difference is that the lower end of the ureter is approached through the wound used to extract the specimen (which is made just above the pubic bone in the front of the abdomen).
After the operation
Laparoscopy does not eliminate post-operative pain however any discomfort experienced should be easily controlled using the pain-killers you will be prescribed. The expected hospital time is between 2-5 days (compared with 7-10 days following open surgery). The stitches used to close the wounds are buried and will dissolve. With laparoscopic nephro-ureterectomy, a urinary catheter will need to remain in place draining the urine from the bladder for a week after surgery (however you will not necessarily need to stay in hospital for all of that time).
Although the incisions are small, a significant operation has taken place internally and as such you should not undertake strenuous physical exercise, even if you feel like it, until at least 3 weeks (A return to full activities may take 6-12 weeks with an open approach). You may drive as soon as you think you could brake hard and swerve quickly to avoid an accident (typically 2 weeks). Follow-up will be different for different people but should be clear before discharge.