Removal of the kidney (simple nephrectomy) is often necessary when a patient develops a poorly-functioning kidney causing problems such as persistent pain, kidney infections, and high blood pressure. Disease in one kidney can damage the function of the other kidney and affect the health of the rest of the body. Traditionally this procedure has been performed through large incisions across the ribcage or upper abdomen, resulting in a potentially long recovery. However, the same procedure can be performed with equal effectiveness laparoscopically, thereby lessening both the recovery and surgical risk.
Scott D. Miller, MD has some of the country’s most extensive private practice experience with laparoscopic kidney removal. Having specialized in urologic laparoscopy for 12 years, he was the first urologist in the state of Georgia to perform laparoscopic removal of the kidney for cancer in 1995. As a result, he has one of the largest series of long-term data following laparoscopic nephrectomy.
Dr. Scott Miller uses a relatively uncommon modification to perform a laparoscopic simple nephrectomy. The kidney does not exist within the abdominal cavity, but rather behind the intestines in a location called the retroperitoneal space. Most kidney removals involve going through the abdominal cavity in order to enter this space. Avoiding the abdominal cavity can minimize recovery and risk of intestinal injury. Although this technique (retroperitoneal laparoscopy) is more difficult to learn, once mastered, it is actually easier for the surgeon (and the patient).
Similar to other laparoscopic procedures, the surgeon makes a button-size incision below the side of the ribcage for the insertion of a telescope (near where one’s elbow would hang while standing). After expanding the retroperitoneal space with carbon dioxide gas, two or three additional small incisions are made to place narrow tubes used for interchangeable instruments. The surgeon can then visualize the kidney and the interchangeable instruments on a television monitor. The kidney’s blood vessels are then tied off and divided. Unlike traditional large-incision surgery, separating the blood vessels early in the procedure prior to manipulating the kidney decreases the risk of blood loss. Once the kidney is separated from all of its surrounding structures, it is placed in a protective plastic bag that closes with a purse-string (all while inside the body).
Since no cancer is suspected, the kidney can be removed in small pieces (morcellation). The neck of the protective plastic bag is brought out through one of the small incisions. An instrument can then be placed into the bag from the outside in order to divide the kidney into small enough pieces to be removed without enlarging any of the small “button-hole” incisions. The skin openings are closed with shower-resistant glue as a substitute for both stitches and bandages.
Results & More
Laparoscopic simple nephrectomy facilitates quicker recovery, less pain, and a lower complication rate as compared to the typical open-incision kidney removal. Our results have either matched or surpassed any other published series for open-incision kidney removal. A vast experience and a world-class surgical team help ensure this high level of success.
Most patients are discharged from the hospital the day following surgery. Risk of transfusion, damage to surrounding organs, blood clots, pneumonia, and wound infection are each under 1%.
Q: How do I keep my kidney(s) healthy?
A: The kidneys are very vascular organs. For that reason, whatever is healthy for the body tends to be healthy for the kidney. The obvious recommendations are exercise, a balanced diet, and management of other medical conditions such as high cholesterol, hypertension, and diabetes. Of course, smoking is detrimental to both kidney and overall health. Although protein restriction is usually unnecessary, seek the advice of a physician prior to starting a high protein diet. A physician can also advise you of any medications to minimize or avoid.
Q: How much pain can I expect after the procedure?
A: Pain is typically less with laparoscopic procedures when compared to open-incision surgery. Some abdominal cramps and shoulder discomfort can occur from the carbon dioxide gas used during surgery. This type of pain is best treated with anti-inflammatories rather than narcotics. Although everyone is different, post-operative discomfort is usually easily managed and short-lived.
Q: Is bruising normal after a laparoscopic procedure?
A: When a narrow tube is placed through a button-size skin incision, a small blood vessel just below the skin can break. However, since the snug fit of this tube will compress the blood vessel during surgery, bleeding will often not occur. If this blood vessel were to re-open at a later time, a small amount of blood could track over a large surrounding area (including the genitalia). This is not a true bruise but will have the same appearance. Most important, this finding is not an indication of internal problems.
Q: When can I return to work or other normal activities following my surgical procedure?
A: Dr. Scott Miller recommends at least two weeks away from work. Very few jobs would require more than four weeks of leave. In many cases, a small amount of light work-related duties are acceptable during the first two weeks. All patients should move around frequently from the time of surgery and resume light exercise at one week (gradually increasing to a normal routine by four weeks). Driving a car is often reasonable in approximately one week if reaction time is good. Of course, Dr. Scott Miller will provide guidance for each individual situation.
Q: How long does the surgery take Dr. Scott Miller to perform?
A: Although many variables can affect the time necessary for Dr. Scott Miller to meticulously perform the surgery, he usually completes the procedure in two hours. However, the time away from family members also includes preparation (30-40 minutes), anesthetic reversal (15-20 minutes), and recovery room stay (2 or more hours). Dr. Scott Miller asks patients to arrive two hours prior to this process, during which time family members can remain present. Occasional updates are given to the family by the operating room nurse. Dr. Scott Miller will come to the waiting area when the patient is ready for transfer to the recovery room.
Q: How long do I stay in the hospital following surgery?
A: Most patients are ready for discharge on the day following surgery.
Q: Should I donate blood prior to my procedure?
A: Since the risk of needing a blood transfusion is less than 1%, blood donation is not necessary.
Q: When can I shower or bathe following my surgery?
A: Since shower-resistant glue was used as a substitute for both stitches and bandages, showering is acceptable once discharged from the hospital. Although water will not harm the surgical areas, mechanical cleansing of the incisions should be avoided for the first week to prevent premature removal of the glue. Complete immersion such as bathing or swimming is allowed at two weeks.
Q: Does kidney size influence whether I am a candidate for laparoscopic simple nephrectomy?
A: Even very large kidneys can be removed laparoscopically.