Radical nephrectomy refers to removal of the entire kidney along with its covering fascia, lymph nodes, surrounding fatty tissue, adrenal gland and upper part of ureter. It is done in cases of renal carcinoma or kidney cancer, when the cancer is localized to the kidney and has not spread to other organs. The procedure can be done by the traditional approach where a large skin incision is made on the flanks or it can be made by making small ports on the side of the abdomen. The keyhole nephrectomy is known as laparoscopic radical nephrectomy. The aim of radical nephrectomy is to remove almost all of the cancer cells within the body to prevent recurrence or spread.
Types of Kidney Cancer
There are two types of kidney cancer. One type originates within the kidney cells and is known as renal cell carcinoma. The second variety originates in the renal pelvis (area where the urine collects and is drained into the ureter) and is known as urothelial cell carcinoma of the renal pelvis.
Types of Kidney Cancer
The common symptoms of kidney cancer include :-
- A Mass in the Abdomen
- Blood in the Urine
- Tiredness
- Loss of Appetite
- Heavy Sweating
- Constant Pain in the Abdomen
- Fever and Weight Loss
Procedure for Laparoscopic Radical Nephrectomy
An initial ultrasonography and CT scan of the abdomen is done to know the exact extent and location of the cancer.
The procedure is carried out under general anesthesia. The patient is made to lie in an incline position at 45 degrees angle to the couch the position is supported by saline bottles kept under the back.
4-5 small cuts of 5-10 mm in length are made in the flank region on the side of the kidney to be removed. A small tube with a camera is passed through one of the holes to visualize the inside of the abdomen. This is called as the laparoscope. A small amount carbon-di-oxide gas is released into the abdomen to inflate it for better visualization of the internal organs. It is extracted later. Once the extent of the cancer is noted, other small instruments are passed through the ports to cut the kidney from its blood vessels, and fascia. The blood vessels are closed. The surrounding fatty tissue, lymph nodes and fascia are resected and pulled out.
One of the ports is slightly enlarged to pull out the kidney. The area is thoroughly searched and cleaned for any remaining cancer tissue. The instruments are removed and the area is stitched up and catheter put in place.
The patient is kept in intensive care for a day or two till the urine production normalizes after which he is shifted to ward. Discharge from the hospital takes place after 4-5 days. Once the catheter is removed the patient can go home. The patient should progress to daily routine slowly as it is a major surgery. He can resume normal activities by 6-12 weeks. Strenuous activities like car driving can take longer and should be done only after physician’s advice. The person should start with a light diet initially till the entire bladder and bowel functions are regained.
The surgery is complex and requires an experienced team of surgeons, nurses and OT technicians.
Advantages of Laparoscopic Radical Nephrectomy
- Minimal blood loss
- Faster recovery
- Shorter hospital stay
- Loss of Appetite
- Lesser postoperative complications and pain
- Lesser chances of infection
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