Hand-Assisted Laparoscopic Nephrectomy
Fact Sheet:
Every year, 28,000 Americans learn they have kidney cancer. A mass on the kidney
may be detected with an ultrasound. Additional testing, including Magnetic
Resonance Imaging, can help determine if the mass is cancerous. Some people with
kidney cancer may notice the presence of blood in their urine, back pain or an
abdominal mass or hard lump. Or, there may be no outward symptoms at all.
Kidney cancer is most common in men over age 40. Unfortunately, the disease
often goes undiagnosed or is misdiagnosed until it has spread. Surgical removal
of the entire kidney may be required. Now, though, there is a less invasive
technique for removing the diseased kidney than traditional surgery.
The procedure is called a laparoscopic nephrectomy and is appropriate for
kidney donors in transplant procedures, too. Jefferson University Hospital is
one of the few medical centers nationwide where this procedure is currently
available.
What is a laparoscopic nephrectomy?
A laparoscopic nephrectomy is a
new, innovative procedure for removing diseased kidneys in place of conventional
surgery. It is a very delicate and precision-oriented procedure, which should be
performed by highly experienced surgeons only. Laparoscopic surgery is sometimes
called "keyhole" surgery because it involves relatively small incisions. The
surgeon uses an endoscope (a narrow telescope) and small "ports" through which
miniature instruments are passed. The scope enables the surgeon to watch what he
or she is doing on video monitors.
In one variation of laparoscopic surgery, the surgeon may use one hand in the
abdomen as a surgical instrument to increase the safety and speed of the
operation. This is called a hand-assisted laparoscopic nephrectomy often used to
remove a cancerous kidney. A device is used which allows the surgeon to insert a
hand through a small incision in the abdomen. The hand-assistance device forms a
seal around the incision that holds the inflated abdomen intact. The kidney is
removed intact by hand for later evaluation by a pathologist.
Can you function normally without a kidney?
The kidneys, part of
the urinary system, are two fist-sized organs located just above the waist, one
on each side of the spine. Their main function is to filter blood and produce
urine to rid the body of waste. Most kidney cancers affect only one organ.
People can function well with just one kidney if a diseased one is removed. In a
few cases where kidney function is impaired, minor dietary restrictions may be
recommended.
What are the advantages of laparoscopic nephrectomy over traditional
surgery?
The laparoscopic nephrectomy is more difficult for the surgeon
to perform than traditional surgery, but the procedure causes less trauma to the
patient. The surgeon makes three small incisions instead of one long
25-centimeter one. Disruption to the abdominal wall is slight. Patients get back
to their lives quicker with this less invasive surgery. The risk of
complications is the same for both procedures, and those risks are minimal and
manageable.
With a laparoscopic nephrectomy, there is reduced postoperative pain and
patients are able to get up and move about within a day. Many are able to return
to work and recreation within two to three weeks. The scarring caused by the
surgery is minimal as well.
With traditional surgery, four or five days of hospitalization are usually
needed after kidney removal, plus six to eight weeks for recovery. Patients of
open surgery typically require heavy pain medication over extended time, too.
Who is a candidate for this procedure?
Ideal candidates for
laparoscopic nephrectomy are those with malignant kidney masses or kidney and
ureter problems requiring removal of the entire kidney or ureter. People who
wish to donate a kidney for transplant can also benefit from this procedure.
Other issues: Patients with kidney masses greater than 12 centimeters
may require conventional surgery. Children can undergo a laparoscopic
nephrectomy if needed, but a modified approach is necessary in infants, toddlers
and very young children. The procedure is also more difficult to perform on
anyone who has had two or more abdominal surgeries.
For more information or for a physician referral, call the Jefferson Kimmel Cancer Center Network at 1-800-JEFF-NOW (1-800-533-3669). The Jefferson Kimmel Cancer Center Network staff
can also make an appointment for you. For health information and education
programs, call 1-888-WELL-123 or use our web site.
Speech- or hearing-impaired callers can access JEFF NOW® by call
1-800-654-5984.
If you are a physician and would like to refer a patient to a Jefferson
urologist for this procedure, please call 215-955-0215.
If you are a patient and would like to make an appointment with
a Jefferson urologist or for more information about this procedure,
call 1-800-JEFF-NOW.
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