Laparoscopic partial nephrectomy - a safe and effective method for removing small kidney tumor while preserving the rest of the body. This is a minimally invasive technique, which provides less discomfort to patients and results corresponding to the results of abdominal surgery.
Compared with the traditional surgical approach through the LPN:
- the patient experiences less postoperative pain;
- It gets better cosmetic results;
- less stays in the clinic;
- previously able to return to work and daily life;
- the results of laparoscopy are identical to the results of open surgery.
Partial nephrectomy has become a standard procedure for patients with renal cell carcinoma .
Indications for surgery:
- Solid kidney tumors in patients with a solitary kidney, or contralateral (hypertrophic) kidney.
- Bilateral renal tumors.
- Small localized tumor of the kidneys in patients with normal contralateral kidney.
Most patients with renal tumors with indications for open surgery can be used or a robotic laparoscopic approach. However, for large tumors (more than 4-5 cm) or metastatic invading surrounding structures - intestines, liver or vena cava - apply abdominal surgery.
The choice of surgery will depend largely on the location of the tumor within the kidney, as well as factors such as obesity and previously performed surgery.
For example, some small-sized tumors can not be removed using laparoscopic surgery due to the location (the ones that are in the center of the body difficult to resect than peripheral).
During consultation surgeon in clinic Assuta will explore the history of the disease, results of analyzes (e.g., CT, MRI or ultrasound). Hold a brief physical examination. The physician will determine if surgery suitable method. Operation will be scheduled in the case of a positive response.
Required types of surveys prior to surgery:
- Physical examination.
- General blood analysis.
- Analysis of blood clotting (coagulation).
- Blood chemistry.
- Analysis of urine.
Prepare for LPN
the list of drugs, the reception of which is necessary to stop a week before the operation:
- vitamin E;
- Plavix and some other drugs for arthritis.
bowel preparation and a liquid diet
Do not eat and water after midnight the day of surgery. It is recommended to drink a bottle of magnesium citrate, which was acquired at the pharmacy the day before.
24 hours prior to laparoscopic partial nephrectomy can drink only clear liquids. It is necessary to follow a diet, below.
- Broth - chicken or beef (without meat, noodles, etc.).
- Juices (apple, grape, cranberry, tan, Hawaiian punch, lemonade).
- Tea (you can with a sweetener, but no cream or milk).
- Coffee (you can with a sweetener, but no cream or milk).
- Jelly without fruit.
- Popsicles (without fruit or cream).
The course of the LPN in Assuta
The operation is performed under general anesthesia using transperitoneal or retroperitoneal approach. When transperitoneal approach stomach is filled with carbon dioxide and perform 3 or 4 small incision in the abdominal cavity. When retroperitoneal access surgeon makes a small incision in the back, inserts a balloon, fills retroperitoneum carbon dioxide, 2-3 additional small incisions are made in the back.
LPN takes approximately 3-4 hours. Carried out on the whole 3-5 small (5-12mm), incision. The surgeon inserts a laparoscope and small instruments using incisions that allows him without too much difficulty to remove the tumor without resorting to the Cavity approach. A defect in the kidney eliminates closure by means of special sealing joints and glue. The tumor is placed in a plastic bag and removed through one of the incisions.
Potential risks and complications
While laparoscopic partial nephrectomy is safe, but as with any surgical procedure there are risks:
- Bleeding. Blood loss during this procedure usually minor, blood transfusions requires less than 2% of patients.
- Infection. All patients should receive intravenous antibiotics before surgery to reduce the risk of infection after surgery. If you develop any signs of an infection after resection (fever, discharge from the incisions, frequent urination, pain, etc.), As soon as possible contact a physician.
- Injury of tissue / organs. Although it rarely happens, it is possible damage to surrounding tissues and organs - intestine, vascular structures, spleen, liver, pancreas and gall bladder - this may require additional surgery. In the kidneys can form scar tissue, causing the need for surgical intervention. Possible injury the nerves or muscles.
- Hernia. This complication develops rarely, since All incisions are carefully closed on completion of the operation.
- Transformation of laparoscopic surgery in the abdominal. Sometimes it is necessary to continue the operation with the help of cavity approach in connection with the difficulties encountered. As a result, the cut can be more than the standard, and this in turn will increase the period of restoration and recovery of the patient.
- Leakage of urine. When you remove a kidney tumor urine collection system is cut, then carefully sutured. If there is a leakage of urine, the need to install drainage pipes. In rare cases there is a need for additional surgery.
In general, the degree of security and compliance risk abdominal surgery.
What to expect after laparoscopic partial nephrectomy?
- Immediately after resection of the patient will be placed in the recovery room, and then transferred to a regular room when he wakes up and the vital signs are stable.
- Post-operative pain. Analgesics are ingested by an infusion pump (patient controlled analgesia) or by injection. The patient may experience some minor pain in the shoulder (1-2 days) related to the supply of carbon dioxide into the abdominal cavity during resection.
- Drainages. Of cut in the renal region at the back may extend for about 2 days liquid partially with blood and urine. Therefore, drainage is installed.
- Ureteric stenting. It may be placed a plastic inner stent at a location between the kidney and bladder to maintain drainage from the kidneys. The stent is left for 2-6 weeks.
- Nausea. The patient may experience nausea associated with anesthesia. Doctors prescribe medicines to eliminate this symptom.
- Urinary catheter. The bladder catheters to drain urine for about 2 days after surgery. Is normal - discharge of urine mixed with blood for several days after resection.
- Diet. The patient is administered an intravenous catheter through which the body fluid enters and medicines. Most of the patients can drink small sips of water to the day of surgery, use ice cubes, they begin to eat the next day.
- Fatigue. This is a common symptom that begins to leave a few days after resection.
- Spirometry. The patient will need to perform some simple breathing exercises to prevent respiratory infections by using a spirometer. Coughing and deep breathing is an important part of recovery and help prevent the development of pneumonia and other pulmonary complications.
- Motion. On the day of surgery it is very important to give the patient to get up in bed and start walking with the help of a nurse or family member, to prevent the formation of blood clots in the legs. Can be used sequential compression devices and special stockings.
- Stay in the clinic. Length of hospital stay for most patients is usually about 2 days.
- Constipation / colic. Perhaps the development of a sluggish bowel syndrome for a few days or weeks. Receiving special preparations are usually helps to cope with this problem. Analgesics can cause constipation, so patients are advised to stop taking these medicines soon after the operation, it will depend on the tolerance.
After discharge from the hospital
After being discharged in a few days may need to take pain medication, then Tylenol is a sufficient means to control pain.
After returning home, you can take a shower. the incision can be wet, but after a shower should be immediately drained them. Do not take a bath during the first two weeks after resection, as this may increase the risk of infection. It is necessary to use special adhesive strips, they have enough for 5-7 days. The stitches will be removed after 4-6 weeks.
It is strongly recommended daily walks. Avoid a long stay in a sitting or lying position. Climbing stairs is possible, but should be carried out slowly. Drive the car should not be, at least 1-2 weeks after resection. For 6 weeks or specified term physician is contraindicated heavy lifting (more than 9 kg) and the following types of physical activity (jogging, swimming, treadmill, cycling). Most patients return to daily activities, an average of 3 weeks after laparoscopic partial nephrectomy. To work it will be possible to come back after about 4 weeks.
You will need to drink plenty of fluids and discuss with your doctor whether or not to restrict the diet of protein or salt intake.
Results after surgery are available, usually within one week. They can be discussed with the surgeon in a meeting or on the phone.
X-rays and blood tests
Each year, patients are advised to take a blood test for creatinine to check kidney function. When the diagnosis - kidney tumors - is necessary to conduct radiological examinations (MRI, CT or ultrasound).
Removal of the urethral stent
The stent is placed in the ureter during laparoscopic partial nephrectomy. Remove it, usually after 2-6 weeks.