Laparoscopic Radical Nephrectomy

WHAT YOU SHOULD KNOW:

• Laparoscopic (lap-ah-ROS-kop-ik) radical nephrectomy (ne-FREK-to-me) is surgery to remove a kidney. The kidneys are two bean-shaped organs found under the ribs on each side of the upper abdomen (stomach). The kidneys remove wastes and other unwanted chemicals from the body. These wastes are flushed from the body in the form of 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 also be removed during laparoscopic radical nephrectomy.
  
  
• You may need a laparoscopic radical nephrectomy when your kidney is damaged. This may be caused by clogged blood vessels, kidney stones, infection, or kidney cancer. These conditions decrease your kidney's ability to control blood pressure and to completely remove harmful wastes from your body. Your caregiver makes small incisions (cuts) on your side where a laparoscope and special tools are inserted. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives your caregiver a clear view of the abdominal area while watching the images on a screen. With this surgery, your kidney problem may be treated and further damage to your kidneys prevented. Your signs and symptoms may decrease and you may resume your usual activities.

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:

• There are always risks with surgery, such as infection or bleeding too much. Problems may happen during your laparoscopic surgery that may lead to an open surgery. Nerves, blood vessels, muscles, and intestines may be damaged. The gas used during surgery may cause shoulder or chest pain for 1 to 2 days after your surgery. Even after a successful surgery, your remaining kidney may not be able to function as well as before. If you have kidney cancer, some cancer cells may have already spread to other parts of your body.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If left untreated, your kidney problem may get worse. If you have kidney cancer, the cancer cells may spread to other areas of your body. These may cause fever, weight loss, weakness, high blood pressure, and decreased amounts of red blood cells. This may affect its ability to completely remove harmful wastes from your body. Too much of these harmful wastes may cause dizziness, headache, seizures, confusion, or fainting. These conditions may cause death, if not diagnosed and treated as soon as possible. Call your caregiver if you are worried or have questions about your condition, treatment, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty its contents.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Tests:
  
  
  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
    
    
  • Computerized tomography scan: This is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your abdomen. It may be used to look for abnormal changes and other problems with your kidneys.
    
    
  • Magnetic resonance imaging: This is also called an MRI. During the MRI, pictures of your abdomen are taken. An MRI may be used to check around your kidneys for other problems.
    
    
  • Renal arteriography: A renal arteriography is done to check for problems with blood vessels in your kidneys. Your caregiver uses a special dye to help blood vessels show up better on x-ray pictures. Tell your caregiver if you are allergic to iodine or shellfish (lobster, crab), as you may also be allergic to the dye used for this test.
    
    
  • X-rays: Before surgery, caregivers may want to have an x-ray (picture) of your abdomen to see any other problems with your kidneys.

During your surgery:

• You are turned to your side after you go to sleep. Your skin is cleaned and then covered with clean sheets. Your caregiver makes 3 to 5 small incisions (cuts) where the laparoscope and other instruments will pass through. Your abdomen is filled with gas (carbon dioxide) to lift the abdominal wall away from the internal organs. Blood vessels are clamped, tied, or cut, and the affected kidney is removed. An adrenal gland and some surrounding tissues may also be removed. Your caregiver checks the surrounding areas for cancer or other problems. The incisions are closed with stitches (threads) and covered with a bandage.
  
  

After your surgery:

You may 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 prevent infection. A caregiver may remove the bandages soon after your surgery to check your wounds.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Food and drink after surgery: You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.