On average, an oncologist sees at least 10 cases of kidney cancer, doctors at Assuta - several hundred, it provides an exceptional level of expertise and knowledge. This level is especially important in surgery of the disease, because it is important to retain the maximum possible amount of authority.
Assuta Hospital doctors provide personalized treatment for kidney cancer , using the most advanced methods of treatment, with the fewest possible side effects.
Indications for nephrectomy
Surgery can cure cancer is only in the early stages, when the tumor is localized in the kidney, or in locally advanced cancer, when struck by the surrounding tissue.
Surgical treatment (nephrectomy operation) can also be used to eliminate the secondary tumor, as well as monitor the development of disease and reduce its manifestations.
On 1 and 2 stages of cancer disease is located within the kidney, can be cured by surgery. At the 3 rd step, when the malignant process affects the nearby lymph nodes, adrenal glands and arteries, it is sometimes possible to eliminate the disease, if a surgeon can remove the tumor completely.
Depending on the stage of the disease part of the kidney may be removed (partial nephrectomy) or all of the kidney (simple nephrectomy). If the kidney is removed, the adjacent lymph nodes and adrenal glands, the operation is called radical nephrectomy.
Partial nephrectomy kidney Assuta
This operation is generally used when the tumor is small and localized. The surgeon removes the tumor and a segment of healthy tissue surrounding it. Part of the kidney is maintained. Doctors call this operation gentle.
This type of surgery is rarely used. Performed when the tumors are detected at an early stage, by chance, in the course of diagnosis of something else. The indication for partial nephrectomy neoplasm is at step 1, at least 7 cm in diameter. In some cases, even when the tumor is small, such an operation is not possible due to the location of tumors.
Radical nephrectomy kidney
In the process of radical nephrectomy, the surgeon removes the kidney with the surrounding tissues therein, including with the adrenal gland and some lymph nodes. The operation is extensive, but if the cancer has not spread, this treatment is necessary.
Nephrectomy, laparoscopic and robotic
Sometimes it is possible to conduct nephrectomy via the laparoscopic approach - through small incisions instead of one cavity. In addition, Assuta Hospital offers the possibility of robotic surgery. These approaches have risks and benefits compared with standard surgical techniques.
Such an operation is minimally invasive because incisions are made small. The surgeon uses a laparoscope equipped with a camera and eyepiece. Performs several sections (3 or 4), through which the doctor inserts the laparoscope and other tools necessary for the operation, remove a kidney or part of it.
Robotic kidney nephrectomy
Robotic surgery, in fact, is laparoscopic. In clinic Assuta a so-called robot Vinci. The operation is performed through small incisions in the abdomen. The possibility of such surgery is only in specialized medical centers.
Nephrectomy performed robot equipped with four arms. In one of them - the camera, in other - surgical instruments. He directs the robot for special surgeon console. Performed incisions, through which instruments and a camera are introduced. After that, take all necessary steps. The surgeon reviews the operating field in 3D, it may increase by 10-12 times.
The advantages of laparoscopic nephrectomy:
- The patient will experience lower levels of pain, need less painkillers.
- hospitalization period will be shorter.
- The patient will be able to recover after the operation much faster.
The disadvantages of laparoscopic nephrectomy
Surgical intervention may take more time, so the longer the patient will be under general anesthesia. In some cases, the surgeon is forced to move to abdominal operation during the procedure. This is due to the fact that the localization and size of the tumor makes it difficult to delete, or have difficulty with bleeding control.
Preparation for nephrectomy
Procedure to remove part or all of the kidney is a major operation. With the patient before nephrectomy talking surgeon, anesthetist, nurse and a physiotherapist. The surgeon will explain in detail what they would do and what to expect when the patient wakes up from anesthesia. At this time, you can ask your questions. A sample list:
- What type of surgery required?
- Is surgery necessary?
- What is the purpose of surgery?
- The operation will be a special team of urologists, surgeons?
- Whether the tumor is completely removed during nephrectomy?
- Is it possible to remove part of the kidney?
- Is there a version of the application of minimally invasive surgery (laparoscopic or robotic)?
- What is the number of such operations performed in the clinic?
- What are their results?
- Are there alternatives to this treatment?
- Will there be pain after the operation?
- What are the long-term and short-term complications of nephrectomy?
- What measures can be taken to to quickly get better after surgery?
- You do need further treatment?
- Follow-up - how often it will be necessary to visit a doctor?
- What are the chances that the cancer can recur?
- What happens if the disease comes back?
The more the patient will know, the less frightening it will seem to him.
If arise difficulties in eating, drinking, intravenous infusion before surgery may be organized. This ensures that no dehydration.
Preoperative diagnosis prior nephrectomy
Before the surgery, the following tests are needed:
- blood tests to check your general health and kidney.
- Chest X-ray lets you know the condition of the lungs.
- ECG is exploring heart health.
If these tests are passed during patient diagnosis of the disease, they do not need to repeat. May be conducted breath tests and ECG with a load, they will help to find out how healthy people to have a good recovery after surgery.
Exercises for the legs and breathing after nephrectomy
The nurse will teach the patient to special exercises for breathing and feet. Their implementation will reduce the risk of nephrectomy complications. Do they need to be as often as recommended.
Breathing exercises reduce the likelihood of infection, leg exercise - the risk of thrombosis. Both of these complications can arise when a person is at rest. Nurses will encourage the patient to get up as early as possible. Since the operation is quite serious in the bed will be required to remain within the first two days.
Immediately after nephrectomy in Assuta
The patient wakes up in the intensive care unit. The state oversees the surgeon, the anesthesiologist, the nurses provide thorough care. Once doctors are sure that the patient gets better, he will be transferred to the ward.
After surgery, the patient is set to different tube life support:
- Droppers, which are used for blood transfusions and fluid.
- Drains from the back and sides to prevent the accumulation of blood, fluid.
- Catheter for urine collection.
If the part of the kidney is removed, installed drainage in the wound area for the collection of urine to prevent it in the wound.
Also located on the arm blood pressure monitor, a pulse oximeter on your finger to measure pulse rate and oxygen in the blood may have an oxygen mask for a while. In the first few hours after the patient wakes up, the nurse will frequently check your blood pressure.
On the first day or longer after nephrectomy can be used in spinal anesthesia Assuta. This method is very effective pain relief. Thin tube is glued to the back, is connected to a pump which delivers a constant dose of analgesic. It is important to inform the nurse if there is a sensation of pain, it may increase the dose.
To analgesia droppers can be used, as well as patient-controlled analgesia manually operated to produce additional analgesic.
After open (abdominal surgery), the patient will experience pain in the first week or so. If laparoscopic nephrectomy was, the state will not be so heavy. There are many different analgesic drugs. When there is pain, it is important to inform the doctor to find the right type and dose of analgesics.
Analgesics are more effective if taken regularly. After surgery on the kidneys need a lot of painkillers, at least in the first three days.
Eat or drink
After operation of any part of the abdomen the intestine often ceases to function for some time. Until the job is resumed, the patient will not be able to eat and drink. First, fluid will flow into the body intravenously. When the patient is able to drink, will not feel sick, the nurse will put an IV and a nasogastric tube. You can try something like tea or soup.
After the restoration of the intestine can be to switch to solid food. This usually occurs at the second or third day after nephrectomy.
For the first time, carefully controlled amount of urine produced. When the amount will correspond to the norm, the catheter will draw. However, the patient will be advised to collect the urine, while he is in the hospital. This amount is compared with the amount of fluid consumed, it is checked how well the kidney or kidneys.
Wound size will depend on the size and location of the tumor and kidney of the type carried nephrectomy. If you had an open surgery, the wound is on his back and side. Or maybe across the chest and abdomen. When the surgery was minimally invasive, there are two or three small wounds. Careful care of them provide a clinic nurse.
Drains remain until it stops draining the fluid, usually from three to seven days. The sutures or clip is removed after about 10 days.
Possible complications after nephrectomy
The most common complications are infections and blood clots.
Infection can develop in the lungs or in the wound. Breathing exercises reduce the chance of infection in the lungs. Nurses provide nursing care, keep the wound clean. If there are any signs of appointed antibiotics. Symptoms of wound infection include redness, pain, swelling.
Blood clots may occur as the person is not moving as much as usual. The patient will be given compression stockings. These stockings with exercise will promote movement of blood. A nurse in the recovery period, encourage the patient to get up and move as much as possible. This will reduce the risk of blood clots. Signs of a blood clot: pain in the leg, usually in the calf muscles, arm or leg swelling, sudden chest pain and shortness of breath.
If you see any of these symptoms, you should immediately inform your doctor. In case of such situations prescribers - heparin, tinzaparin or dalteparin - daily injections.
About a week after nephrectomy, the patient can leave the clinic. If there was a laparoscopic surgery, prescribe before.
Treatment after nephrectomy
When the tumor has been completely removed, no further treatment is required. If the surgeon is concerned, the cancer cells may remain, the doctor will discuss the possibility of biologic therapy with the patient. It can be recommended radiation therapy.
Although many treatments have been tested in the course of research trials, there is currently no treatment that can reduce the risk of recurrence after surgery. Clinical trials of biological methods.
Palliative nephrectomy - relieving symptoms
Even if the cancer can not be cured by surgery, surgery may be needed to remove it. This surgery may also be called palliative nephrectomy. Sometimes the primary tumor causes unpleasant symptoms that can be successfully treated by removal of the kidney. Swelling causes local pain or blood in the urine. The patient may experience symptoms such as fever or weakness.
Malignancy can change the chemical levels in the blood, causing nausea and drowsiness. Tumor releases the so-called cytokines that trigger these symptoms. Removal of neoplasms would reduce or eliminate the data displays.
In addition, the elimination by the kidneys can slow the spread of cancer outside the body. Two recent clinical trials have shown that patients with metastatic cancer may live longer if the affected kidney was removed. Therefore, the procedure may be appropriate if:
- It is the primary tumor that can be surgically removed.
- When kidney cancer cause painful symptoms.
- If the secondary focus of small size.
- When the patient's general condition will allow him to recover after nephrectomy.
Operations in advanced kidney cancer
Such surgical procedures slow down disease progression, prolong survival, improve the condition and quality of life. In some cases, you can cure the disease by removing the area of distribution. This is possible if the secondary cancer of the kidney hit the lung, liver, bone (in rare cases), skin.
removal of metastatic cancer surgery different, depending on the specific medical situation. Information is provided in full by your doctor.
If the operation is not possible with kidney cancer
When the tumor is small, but the patient does not permit the operation, the doctor may recommend cryotherapy (destruction of cancer by freezing) or radio frequency ablation (by radiowave treatment).
This is a procedure that blocks the main blood vessels leading to the kidney with the tumor. It reduces body supply oxygen and nutrients, leading to a reduction in the tumor.
This treatment is recommended in the early stages of kidney cancer when the patient's condition does not allow surgery to remove part or the entire kidney. Arterial embolization does not cure cancer, because it is not removed from the body, and there is a chance that the cells can penetrate into other parts of the body in the future.
This procedure can be carried out in the department of radiology. Requires hospitalization for 1 day. Local anesthesia, and the patient is given a sedative. The doctor inserts a catheter into a blood vessel in the upper leg, brings it to the kidney and delivers the substance blocking the artery. The catheter is removed, the patient is sent to the House.
He needs rest, at least for four hours. It may be a pain at the site of treatment for a day or two, doctors give painkillers. There may be some side effects caused by cancer cells dying off. Cells are able to release toxins that cause high temperature, sweating, weakness, fatigue in a few days. In some cases, the recommended intake of paracetamol every 6 hours until the condition improves.