LAPAROSCOPIC NEPHRECTOMY

Laparoscopic Nephrectomy :

Laparoscopic nephrectomy is a surgical procedure in which surgeon remove the kidney,It is done most often because a kidney has become diseased and no longer function this conditions is known as kidney failure, renal failure, renal insufficiency or kidney insufficiency. 

A kidney infection that impairs kidney function can also be a reason for kidney removal surgery. 

Kidney infection start through bladder as a lower urinary track infection. More rarely patient can get a kidney infection if bacteria enters your blood during surgery and reach to kidney, in other cases, not treating a bladder infection quickly enough gives it a chance to turn into a kidney infection. 

Such infection are classified as an acute kidney infection or chronic kidney infection. 

Acute kidney infection occurs in a relatively short period of time, is characterized by severe symptoms 

Its often caused by germs and infection that migrate upward from the bladder through the ureters.

A chronic kidney infection takes a long time to develop and gets progressively worse

These are usually no symptoms that anything is wrong untill significant kidney damage has been done and without treatment, it can result is kidney failure. 

-Benefits of laparoscopic nephrectomy 

Reduce blood loss and transfusion. 

Reduce pain

Shorter hospital stay

Improved cosmesis

Fast recovery as compared to open surgery 

-Causes of nephrectomy or kidney removal:

Kidney becoming cancerous and life threatening for the patient. 

Severe injury or trauma to the kidney,  

Kidney removal surgery is necessary in transplant procedure 

Because of birth detect or congenital disease. 

Continous smoking 

Risk is more than men than women 

Obesity is also cause for kidney disease.

Genetic conditions like von hipple vindau (VHL) disease or inherited papillary renal cell carcinoma. 

Family history of kidney disease 

High blood pressure from long time it causes renal artery stenosis. 

-Common sign and symptoms :

Fatigue due to cancer, which is chronic unexplained tiredness.

Kidney cancer have anemia or low blood cells.

Shortness of breath, rest issues, vomiting, frequently in the morning. 

Dizziness, losing all appetite, Pale and light skin, Head pains, dry skin, pain in bones.

Unexpected & rapid weight loss without making an effort to lose weight. 

Recurring fever due to infection, leg or ankle swelling, unnecessary thirst.

Blood in urine and stool.

Kidney infection. 

Kidney stones.

Cyst in the kidney, Side or back pain.

A mass or lump in the side or lower back.

Issue with sexual capacity and menstrual periods stop (Amenorrhea).

-Other common causes and habits that causes kidney failure :

Not emptying bladder timely. 

Insufficienct water intake

High salt consumption 

High protein diet

Ignoring common infection 

Consuming too much caffeine 

Drinking excessive alcohol 

Lack of sleep 

Taking daily analgesic tablets or pain killer.

Pre-operative instruction for the patient: 

If patient taking blood thinners like aspirin, plavix, coudamin discuss with surgeon whether patient should continue or stop medication before surgery. 

If patient smoke its stop before the surgery because its increasing the risk of complications. 

Don't eat or drink anything after midnight or night before come to the hospital. 

Leaves valuable or costly items and accessories at home but come with medical insurance card and identity card

Pre surgery patient get epidural pain catheter for helping to reduce pain after the surgery. 

Pre surgery catheterization done for the drainage of urine.

Before the surgery, patient undergo imaging procedure, such as computed tomography (CT) and sonography  an assessment of cardiovascular fitness patient also meet with an anestheologists prior to the procedure. The preoperative blood and urine testing is similar before surgery. 

Laparoscopic nephrectomy  done under the full general anesthesia with  endotracheal tube.General anesthesia for pain relief during surgery and comfort to patient.patient asleep during whole surgery. 

Fentanyl citrate and muscle relaxtant given to the patient and Endotracheal intubation will given and hypnotic agent like propofol given. 

Than anesthesist continue watching monitor and watch vital signs including pulse, spo2(saturation ), E.C.G,  body temperature and blood until the  patient  will not shifted from operation theatre to general ward.

:Procedure of laparoscopic nephrectomy -

In this procedure surgeon give 3 to 4 incision the abdomen which is less than 1cm for inserting the 5mm and 10mm trocar,  surgeon insert the veris needle for inflate the abdominal cavity by carbon di oxide gas for creating  sapce inside the abdominal cavity for working because surgery perform inside the abdomen by the looking at the monitor screen. After the introducing the co2 gas surgeon insert the 10mm telescope which is standard laparoscope which attached with video camera and connect the xenon cold light source and co2 cable attached  form trocar channel, after the visualization surgeon insert another 5mm trocar for inserting 5mm laparoscopic instruments like grassper and marinland after that sugeron inspect the abdominal cavity and  surgeon remove the fat and cut the renal artery & vein, ureter and clipping by hemolock clip and titanium clip after that remove the kidney by giving 3 to 5 cm incision above the abdomen and place abdominal drain for drainage output and close the incision by suturing aur stapler  and dressed by waterproof dressings or cotton pad.

:After the Surgery -

After the surgery patient shifted in recovery room and some time patient shifted in intesive care unit from operation theatre for watching close monitoring for 2 to 4 hours when patient stable than shifted to general surgical ward.

Postoperative Pain manage by giving painkiller intravenously and by epidural catheter. patients may feel pain in the first few days after surgery mild pain at their incision sites, this is controlled by pain medication. Patient may experience some minor shoulder pain (1-2 days) because of carbon dioxide gas used to inflate your abdomen during the surgery 

Urinary Catheter or foley's catheter is placed to drain urine your bladder at the time of surgery. By nurse monitor your urine output over the first day or second day of the surgery. This removed by your nurse once patient  are stable and walking comfortably on the first postoperative day. 

next day from the surgery patient keep on liquids diet . Hydration and nutrition maintain by giving intravenously fluid after the 2 to 3 days surgery from second patient can take semi solids diet and slowly after the few days patient can eat normal diet as per deition advice.

Spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections through use of an incentive spirometry device (these exercises will be explained to you by the nursing staff during your hospital stay). Coughing and deep breathing is an important part of your recuperation and helps prevent pneumonia and other pulmonary complications.

Aftet surgery patient have drain for removing drainage, amount of the drain recorded by nurse in 24 hours periods

After the few days of surgery a nurse or care-partner help patient in walking but remember patient ambulate or walk with drain.

Spirometer or pulmonary care for practice of deep breathing its a plastic device and also chest-PT done by physiotherapist for reducing cough and breathing problem 

Hospital Stay in laparoscopic nephrectomy is generally 3-4 days.

What are the complications after the surgery?:

As with any major surgery, complications, although rare, may occur with laparoscopic nephrectomy. Potential risks and complications with this operation include:

Nausea can occur due to general anesthesia for same day  This is manage  by medication. 

Fatigue is quite common following surgery and should subside in a few weeks following surgery.

Internal bleeding may occur after the surgery and some bleeding may occur port site, but are rare.

Infection may occur like wound infection, urinary track infection 

Injury to near by organ

Incisional Hernia because of the small laparoscopic incisions, hernias at these sites occur rarely.

After the discharge from the hospital :

If patient experience following 

symptoms or problems then immediately contact the doctor:

-Severe persistent pain not relief by medication and rest.

-Difficulty obtaining medication any new onset of or increased weaknesses numbness or tingling.

-Persistent chills new onset of fever over 101° degree farehnit or night sweat.

-Any redness, swelling drainage, heat or pain around incision. 

-Any new onset of chestpain or shortness of breathing. 

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DR.ASHISH CHHAJAD - MBBS, MCH (UROLOGY) DNB UROLOGIST AND ANDROLOGIST 

Specialised in Kidney stones & treatment Ureteroscopy, Pcnl, Mini Perk, Benign Prostate disease treatment, TURP Uro -Oncology Laparoscopy Female urology , surgery for stress incontinence, fistulas .Paediatric urology surgery- PUValves, VUR surgery, Hypospadias Andrology & Male Infertility Men’s sexual healthReconstructive urology surgery Urethral stricture - Endoscopic surgery & Urethroplasties, Renal Transplantation surgery, Lithotripsy.