Laparoscopic Nephrectomy or Donor Nephrectomy (removal of kidney)

A. The Condition. You may have a tumor of your kidney that requires removal with surgery. Alternatively, you may be donating one of your healthy kidneys to an individual who does not have any working kidneys. This latter operation is known as a donor nephrectomy. Your body can function just fine with one kidney.

B. Symptoms. If you are undergoing a donor nephrectomy, then you should not have any symptoms. If your are undergoing a nephrectomy because of tumor, then you might have the following symptoms:

• Weakness
• Loss of appetite
• Weight loss
• Abdominal pain
• Blood in urine

C. Laparoscopic Nephrectomy. The surgeon will make about 3-4 small incisions in your abdomen and side, where the kidney will be removed. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to perform kidney removal. The kidney is extracted intact inside a plastic bag from your body by enlarging one of the small incisions on your side. If this is a donor nephrectomy, then the kidney is given immediately to the transplant surgeons, so that they can implant the kidney into the recipient. After this has been accomplished, the carbon dioxide is released out of your abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

D. Nonsurgical Treatment. For most tumors or masses of the kidney, the best treatment is surgical removal, especially if the diagnosis is not known. In some cases, the tumor may be treated by placing a special probe into the tumor; the probe can deliver various types of energy which can destroy the tumor. Your doctor will discuss with you what your best treatment option is.

E. Risks. The primary risks of laparoscopic nephrectomy are:

• Infection of the skin at one of the small ports sites
• Bleeding within the abdomen
• Intestinal injury
• Postoperative ileus (the intestines slow down/stop working for several days)

F. Expectations

1. Before Your Operation. Laparoscopic nephrectomy usually is an elective procedure. The preoperative evaluation might include blood work, urinalysis, an abdominal ultrasound, an abdominal CT scan, and possibly a nuclear medicine study. In some cases, cystoscopy of your bladder may be performed. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home in 2-4 days after a laparoscopic nephrectomy. You may need to wait until your bowels start working. You will be given medication for pain. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• Severe pain
• Nausea and vomiting
• High fever
• Odor or increased drainage from your incision
• No bowel movements for three days
• Difficulty urinating

G. Pertinent References

Dunn MD, Hsu J. “Minimally Invasive Transperitoneal Nephrectomy.” In: Frantzides CT, Carlson MA, eds. Atlas of Minimally Invasive Surgery. Philadelphia: Saunders Elsevier, 2009.