LAPAROSCOPIC NEPHRECTOMY AN INFORMATION LEAFLET Written by: Department of Urology May 2011 Stockport: 0161 419 5698 Website: www.stockport.nhs.uk Tameside: 0161 922 6696/6698 Website: www.tameside.nhs.uk Macclesfield: 01625 661517 1 of 8
What Is A Nephrectomy? Most people have two kidneys, one at each side at the back of the abdomen. They filter the blood in your body to remove waste products, which are passed out of the body in your urine. Urine is carried by a tube (ureter), leading from each kidney to the bladder. When the bladder is full, urine passes out of your body through a tube called the urethra. A simple nephrectomy involves removing the whole of one kidney. A radical nephrectomy is the removal of one kidney and the tissues around it. These include the adrenal gland, which is attached to the kidney and some lymph nodes situated near the kidney. In some cases the ureter is also removed (this would be called a nephroureterectomy). Laparoscopic means the use of telescopic instruments to look inside the abdomen and gain access to the affected kidney. The Surgeon will make three to five small incisions (cuts) of about 0.5cm to 1 cm in length on the same side of the abdomen as the kidney to be removed. These incisions are called entry sites or ports and the laparoscopic instruments are inserted into the sites and are then used to cut out the kidney. A small cut may be made in the lower part of the abdomen to remove the kidney whole. The operation is carried out under a general anaesthetic (when you are asleep). What Are The Benefits? Nephrectomy can be carried out because; your kidney is damaged and not working properly. you have cancer in your kidney the kidney is damaged due to chronic infection the kidney is damaged due to injury the kidney is not working properly due to kidney stones in order to donate a kidney 2 of 8
The aim of the operation is to remove the kidney that is affecting your health. If cancer is present, the aim is to remove all the cancer, so that the extent of the disease can be assessed (staging) and will help the urology doctors decide if you need further treatment. Are There Any Risks Involved? Conversion to the standard open operation. There is a one in ten chance (10%) that we would have to convert to the standard open procedure to remove the kidney, if access to the kidney is difficult or if the operation is not progressing as planned. This open procedure involves making a larger cut in the upper abdomen between the lower ribs on the same side as the affected kidney. The recovery period and stay in hospital may be longer following an open procedure. Pain The Ward staff will give you painkillers to control any pain you may have. This may be in the form of a device that you use to control your pain yourself. This is known as a patient controlled analgesia (PCA) and you will be shown exactly how to use it. Pain relief may also be administered by an epidural (needle inserted in your back). Bleeding - A blood transfusion may be needed to replace blood lost during the operation. Very occasionally, there may be internal bleeding after the operation making further surgery necessary. Bruising or infection in the wound If your wound appears very reddened and/or has a discharge (pus), you may require some antibiotics. Blood clots in the leg (deep vein thrombosis/dvt) As you are not able to move around immediately after the operation, blood clots may form in your leg, which can occasionally lead to a clot in the lungs (pulmonary embolus/pe). Moving around as soon as possible after your operation can help to prevent this and you may be given special surgical stockings to wear, whilst you are in hospital and possibly injections to thin the blood. You may also be shown how to perform leg exercises, to help prevent blood clots occurring. Chest infection this is due to the effects of the anaesthetic and you may be taught deep breathing exercises by a physiotherapist, which you should do regularly after your operation, to help prevent a chest infection. Possible need for further treatment If cancer is present in the kidney and the surgeon is unable to remove it completely, further treatment may be necessary. Renal dialysis (a procedure to remove waste products from the blood) In most cases you will still have one kidney, which will continue to work. However, if you only had one kidney before the operation or if your remaining kidney is not working properly after the operation or becomes damaged you may need renal dialysis. 3 of 8
What Are The Alternatives? In some cases it may be possible to perform: A partial nephrectomy (only the affected part of the kidney is removed) An open nephrectomy (larger abdominal incision) embolisation of the kidney (a treatment that cuts off the blood supply to the tumour). Your surgeon will be able to tell you if any of these is suitable for you. You may choose to do nothing, although if cancer is present, it is likely that this will progress and your health may deteriorate. You may wish for your care to be transferred to the palliative care team, whose aim is to improve quality of life, rather than saving lives. If this is the case, please let us know. How Long Will I Be In Hospital For? Patients usually stay in hospital for four to six days after a laparoscopic nephrectomy but no two patients are the same. This will depend on how well you progress following your operation. What Happens To Me When I Arrive At The Ward? You will usually come into hospital on the day of your operation. You will meet the nursing staff who will be looking after you and an anaesthetist, who will discuss your options for pain relief following the operation and also talk to you about the anaesthetic you will have. On the Day of the Procedure: You will have nothing to eat or drink for several hours before the operation. If you would normally take tablets during this time, you will be informed at the pre-operative assessment clinic which you should continue to take. You may be given some tablets as part of the preparation for your anaesthetic, known as a premed. These will help you feel more relaxed. Before going to the operating theatre, you may be asked to take a bath or shower and change into a theatre gown. Any make-up, nail varnish, jewellery (except your wedding ring), dentures and contact lenses must be removed. What Happens After The Procedure? When you come out of theatre, you will be transferred to the recovery area before you are transferred back to your ward. You may still be very sleepy at first and will be given oxygen through a face mask. If you require close monitoring, you may be nursed in the High Dependency Unit (HDU) until you are ready to return to the main ward. 4 of 8
The ward staff will give you painkillers to control any pain you may have. You will have a drip running into a vein to give you fluids until you are able to drink normally, which is usually the day following the operation. You will gradually increase your fluid and food intake over the next few days and the drip will then be removed. You will have a small plastic drain tube, attached to a drainage bag. This is to drain any fluid which collects under your wound and is usually removed one to two days after the operation. You will have a catheter (tube into the urethra draining urine from the bladder), so that the amount of urine you pass can be measured. This will be removed when you are more mobile. You will be encouraged to breath deeply after your operation and move your legs in bed. The nursing staff will help you to get out of bed on the first and second day after the operation and help you start walking soon after this. You are normally up and about independently about two to three days after surgery. Discharge Arrangements You will normally be ready to go home about five to seven days following the operation. You will be required to arrange for a responsible adult to collect you from hospital. You will be given seven days supply of any medications you have been prescribed and a letter will be sent to your GP informing them of your treatment and progress. An outpatient appointment will be arranged for you to be seen in your local urology department about six to eight weeks after the operation. The results of your surgery will be discussed with you, as well as any further treatment that may be necessary. Day To Day Living Going back to work - This will depend on the type of job that you do and how you feel. You should get back to feeling like your normal self after about two and three weeks following this procedure but may need a longer period of time than this off work, until you are feeling completely well. Driving - You should avoid driving for three weeks and should contact your car insurers for advice on driving following this type of surgery. Exercise -Take gentle exercise about two to three weeks after your operation e.g. walking or swimming. Remember, you have had a major operation and should take rest whenever you feel the need to. Drink plenty of fluids and pass urine regularly to help keep your remaining kidney healthy. If there is a Problem 5 of 8
If you have a problem following discharge from hospital, please contact your GP for advice. Other Useful Contacts or Information It is important that you have as much information as you would like before you agree to have this operation. If you have any questions about your treatment, do not be afraid to ask your doctor or nurse. You may be feeling a wide range of emotions and for some people undergoing surgery can be a frightening and unsettling time. It may help you to talk about how you are feeling to someone who specialises in dealing with this condition, such as your Urologist or the Urology Specialist Nurse. They will listen, answer any questions you may have, or can put you in touch with other professionals or support agencies if you wish. Some useful contact numbers are listed below; Macmillan Cancer Support 89 Albert Embankment London SE1 7UQ Tel - 0808 808202 www.macmillan.org.uk (provides specialist advice through Macmillan nurses and doctors and financial grants for people with cancer and their families.) Cancer Backup Bath Place Rivington Street London EC2A 3JR Tel - 0808 8001234 (freephone information line, Monday to Friday, 9am to 7pm) www.cancerbackup.org.uk (provides information on all aspects of cancer and its treatment and on practical and emotional problems of living with cancer) Greater Manchester and Cheshire NHS Cancer Network website www.gmccn.nhs.uk (website with information about all aspects of cancer and details of support for people affected by cancer). Kidney Cancer UK Administration Office PO Box 2473 Uttoxeter Staffordshire ST14 8WZ. Tel - 01889 565801 www. kcuk.org 6 of 8
If you have any questions you want to ask, you can use this space below to make notes to remind you. Source In compiling this information leaflet, a number of recognised professional bodies have been used, including Greater Manchester and Cheshire Cancer Network and the British Association of Urological Surgeons. Accredited good practice guidelines have been used. If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Health Information Centre on 0161 922 5332 If you would like any further information please telephone the Urology Nurse Specialists at your local Urology Department on: Stepping Hill 0161 419 5695 Tameside 0161 922 6696/6698 Macclesfield 01625 661517 7 of 8
Author: Division/Department: Date Created: Reference Number: Version: Greater Manchester and Cheshire Cancer Network / Urology Department Elective Services November 2009 Version 1.2 8 of 8