Minimally Invasive Nephrectomy – Dr. Aydin Pooli MD

Minimally invasive nephrectomy is a surgical procedure to remove a kidney. This procedure is done through several small incisions in the abdomen. You may have surgery to:

Remove the entire kidney and some surrounding structures (radical nephrectomy).
Remove only the damaged or diseased part of the kidney (partial nephrectomy).

You may need this surgery if:

Your kidney is severely damaged from disease, infection, or cancer.
You were born with an abnormal kidney.
You are donating a healthy kidney.

Tell a health care provider about:

Any allergies you have.
All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
Any problems you or family members have had with anesthetic medicines.
Any blood disorders you have.
Any surgeries you have had.
Any medical conditions you have.
Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

Bleeding.
Infection.
Damage to other body structures near the kidney.
Urine leaking into the abdomen.
Pneumonia.
A blood clot that forms in the leg and travels to the lung (pulmonary embolism).
Allergic reactions to medicines.

A bone (usually part of a rib) or more tissue may need to be removed so the surgeon can get to the kidney. If this happens, the minimally invasive procedure may need to be changed to an open procedure.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
6 hours before the procedure – stop drinking milk or drinks that contain milk.
2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
Taking over-the-counter medicines, vitamins, herbs, and supplements.

Surgery safety

Ask your health care provider:

How your surgery site will be marked.
What steps will be taken to help prevent infection. These steps may include:
Removing hair at the surgery site.
Washing skin with a germ-killing soap.
Taking antibiotic medicine.

General instructions

Do not use any products that contain nicotine or tobacco for at least 4 weeks before the procedure. These products include cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.
Your health care provider may instruct you to do breathing exercises before the procedure to help prevent pneumonia. Do these exercises as directed.
You may need to have your blood drawn (type and cross) in case you need to receive blood (get a transfusion) during the procedure.
Plan to have a responsible adult take you home from the hospital or clinic.
Plan to have a responsible adult care for you for the time you are told after you leave the hospital or clinic. This is important.
What happens during the procedure?

Before surgery begins

An IV will be inserted into one of your veins.
You will be given a medicine to make you fall asleep (general anesthetic).
Your health care provider may take steps to help blood flow in your legs. You may have:
Tight stockings, also called compression stockings, on your legs.
Compression sleeves wrapped around your legs. A machine called a sequential compression device (SCD) will pump air into the sleeves.
A small, thin tube will be placed in your bladder (urinary catheter) to drain urine.
A tube will be placed through your nose and into your stomach (nasogastric tube) to drain stomach fluids.

During surgery

A small incision will be made in your abdomen to insert a thin, lighted tube (laparoscope) with a camera attached. This lets your surgeon see your kidney during the procedure.
More small incisions will be made to insert other surgical tools. One incision may be slightly larger to remove your kidney.
In some cases, the surgeon will do the procedure by controlling tools that are attached to a surgical robot. This is called a robot-assisted nephrectomy.

The next steps depend on the type of procedure you are having.
If you are having a partial nephrectomy:

The blood vessels attached to your kidney will be clamped.
Part of your kidney will be removed. The kidney will be closed with stitches (sutures), and the clamp on the blood vessels will be removed.

If you are having a radical nephrectomy:

All of the blood vessels that attach to your kidney will be closed and cut.
Part of the tube that carries urine from your kidney to your bladder (ureter) will be removed.
Your kidney will be removed.
All of the surgical tools will be removed from your body.
A small tube (drain) may be placed near one of the incisions to drain extra fluid from the surgery area.
The incisions may be closed with sutures or another type of closure.
A bandage (dressing) will be placed over the incision area.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
Your nasogastric tube will be removed.

You may continue to have:

An IV until you can drink fluids on your own.
A urinary catheter. Your urine output will be checked.
A drain. Your surgical drain will be removed after a few days. Your health care provider will tell you how to care for the drain at home.
Pain medicine. This will be given through your IV.
Compression stockings or compression sleeves. This helps to prevent blood clots and reduce swelling in your legs.

You will be encouraged to:

Get out of bed and walk as soon as possible.
Do breathing exercises, such as coughing and breathing deeply. This helps prevent pneumonia.

Summary

Minimally invasive nephrectomy is a surgical procedure to remove a kidney. In some cases, only the damaged or diseased part of the kidney is removed.
This procedure is done through several small incisions in the abdomen.
Follow instructions from your health care provider about taking medicines and about eating and drinking before the procedure.
You will be given a medicine to make you fall asleep (general anesthetic) during the procedure.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

Minimally Invasive Nephrectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

Pain.
Soreness and numbness in the area around your incisions.

Follow these instructions at home:

Medicines

Take over-the-counter and prescription medicines only as told by your health care provider.
Avoid using NSAIDs regularly over a long period of time. These include aspirin and ibuprofen. Doing so may damage your remaining kidney.

Ask your health care provider if the medicine prescribed to you:

Requires you to avoid driving or using machinery.
Can cause constipation.

You may need to take these actions to prevent or treat constipation:

Drink enough fluid to keep your urine pale yellow.
Take over-the-counter or prescription medicines.
Eat foods that are high in fiber, such as beans, whole grains, and fresh fruits and vegetables.
Limit foods that are high in fat and processed sugars, such as fried or sweet foods.

Incision care and drain care

Follow instructions from your health care provider about how to take care of your incisions. Make sure you:

Wash your hands with soap and water for at least 20 seconds before and after you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
Change your dressing as told by your health care provider.
Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.

Check your incision area every day for signs of infection. Check for:

Redness, swelling, or more pain.
Fluid or blood.
Warmth.
Pus or a bad smell.
If you have a drain in place, follow your health care provider’s instructions for drain care. This may include emptying the drain and keeping track of the amount of drainage.

Activity

Rest as told by your health care provider.
Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
Do not play contact sports. Doing so may damage your remaining kidney.
Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Catheter care

If you have a urinary catheter, care for it as told by your health care provider. You may be told to:

Wash your hands with soap and water for at least 20 seconds before and after touching the catheter, tubing, or drainage bag. If soap and water are not available, use hand sanitizer.
Empty the drainage bag every 2–4 hours, or more often if needed. Do not let the bag get completely full.
Monitor the amount and color of your urine as told by your health care provider.
Keep the area around the catheter clean and dry.
Make sure to keep the catheter secured to avoid pulling and accidental removal.
Always keep the urine collection bag below the level of your bladder.
Check the catheter tubing regularly to make sure there are no kinks or blockages.
Make sure that the catheter is not placed under water.

General instructions

Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
Do deep breathing exercises as told by your health care provider. These help to prevent lung infection (pneumonia).
Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
Keep all follow-up visits. This is important.

Contact a health care provider if:

You have a fever or chills.
You have pain that is not controlled by your pain medicine.
You have redness, swelling, or more pain at an incision site.
You have a cough.
An incision is warm to the touch.
You have blood in your urine.
You have not had a bowel movement in 3 days.
You have diarrhea.

Get help right away if:

You have trouble breathing or feel short of breath.
You have chest pain.
You have severe pain.
There is fluid or blood coming from an incision.
There is pus or a bad smell coming from an incision.
You cannot urinate.
You have warmth, redness, and tenderness in your leg.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

Follow instructions from your health care provider about how to take care of your incisions. Check your incision area every day for signs of infection.
Take over-the-counter and prescription medicines only as told by your health care provider.
Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
Keep all follow-up visits. This is important.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.