Laparoscopic Partial Nephrectomy

What you should know

• Laparoscopic (lap-ah-ROS-kop-ik) partial nephrectomy (ne-FREK-to-me) is surgery to remove a part of your kidney. When the part of your kidney that is diseased or damaged is removed, healthy parts of your kidney are able to keep working. The kidneys are two bean-shaped organs found under the ribs on each side of the upper abdomen. Their job is to remove wastes and other unwanted chemicals from the body. These wastes are flushed from your body in your urine. On top of each kidney is an adrenal gland, which is an organ that makes hormones. Hormones are special substances that control some functions of your body. The adrenal gland and other tissues may be removed during this surgery.
  
  
• You may need a laparoscopic partial nephrectomy when your kidney is damaged. This may be caused by blocked blood vessels, kidney stones, infection, or kidney cancer. These conditions decrease your kidney's ability to control blood pressure and remove wastes from your body. With this surgery, your kidney problem may be treated, preventing more kidney damage.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• Risks with surgery include infection, bleeding, and blood clots. Problems may happen during your laparoscopic surgery that may lead to an open surgery. Nerves, blood vessels, muscles, and your bowels may be damaged. The gas used during surgery may cause shoulder or chest pain for 1 to 2 days after your surgery. After surgery, your kidney may not work as well as before. If you have kidney cancer, some cancer cells may have already spread to other parts of your body.
  
  
• If you do not have the surgery, your kidney problem may get worse. If you have kidney cancer, the cancer cells may spread to other areas of your body. Your kidney may not be able to remove wastes from your body. These wastes may cause dizziness, headache, seizures, confusion, fainting, and even lead to death. Call your caregiver if you are worried or have questions about your condition, treatment, or care.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• If you are a woman, tell your caregiver if you know or think you might be pregnant.
  
  
• You may need to have x-rays, computerized tomography (CT) scans, or an magnetic resonance imaging (MRI). A test called renal arteriography may also be done. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• You may be given medicine to help you sleep.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• Ask caregivers about directions for eating and drinking.
  
  
• Bowel preparation: You will need to empty your bowel to get ready for this surgery. Your caregiver may ask you to do one or more of the following:
  
  
  • You may need medicine called an enema. An enema uses warm water that is put into your rectum to help empty your bowel. Ask your caregiver how to do this, and follow the directions on the package.
    
    
  • You may be given 8 to 12 (eight-ounce) cups of bowel preparation medicine to drink. Drink one eight-ounce cup of bowel prep medicine every 10 minutes until your urine is clear. Ask your caregiver for more information about this medicine.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Bowel preparation:
  
  
  • Do not eat or drink anything on the morning of your surgery. Your bowel needs to be empty during your surgery. If you need to take medicines, you may have them the morning of your surgery with few small sips of water.
    
    
  • You may need a warm water enema the morning of your surgery.
    
    
  • You may be asked to drink 4 to 8 (eight-ounce) cups of bowel preparation medicine. This may need to be done if you drank the medicine the night before.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be taken on a stretcher to the room where the surgery will be done. General anesthesia medicine will be given to keep you asleep during the surgery. You will be placed lying on your side. Your skin will be washed and covered with clean sheets.
  
  
• Your caregiver will make 3 to 5 small incisions (cuts) on your abdomen (stomach). Your abdomen will be filled with gas (carbon dioxide) to lift your abdominal wall away from your organs to help caregivers see your kidney. Blood vessels will be clamped, tied, or cut, then the damaged part of your kidney will be removed. One of your adrenal glands, and other tissue may also be removed. Your caregiver will check the area for cancer or other problems. The incisions will be closed with stitches and covered with bandages.

After your surgery:

You will be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to help prevent infection. A caregiver may remove the bandages to check your wound.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• Your signs and symptoms are getting worse.

Seek Care Immediately if

• You have a fever.