Urology Department Laparoscopic Radical Nephrectomy Information
Aims of this leaflet To give information on the intended benefits and potential risks of kidney surgery To guide you in the decisions you will make with your doctor To help you identify questions about issues which are important to you. What is a Laparoscopic Radical Nephrectomy? This is the removal of your kidney which is thought to contain cancer. Following surgery you will notice 3-4 small abdominal skin incisions and one larger one in the lower abdomen from which the kidney was removed. Before the operation You will be asked to attend a pre-operative assessment clinic about 1 week before your operation. This will be carried out by one of the pre-operative assessment nurses, who will assess you for the operation. You will be required to have necessary blood and urine tests and may require an x-ray and heart tracing (known as an electrocardiogram or ECG). We advise that you allow at least a couple of hours for this appointment. Are there any risks with the operation? Most procedures have a potential for side-effects. You should be reassured that, although all these complications are wellrecognised, not all patients will suffer from them. The commonest complications of surgery are bleeding, infections and blood clots (known as deep vein thrombosis or DVT) 2
Other complications are as follows: Common (greater than 1 in 10)* Temporary shoulder tip pain Temporary abdominal bloating Temporary insertion of a bladder catheter and wound drain Recurrence of disease elsewhere in the body which requires regular follow-up Occasional (between 1 in 10 and 1 in 50)* Bleeding, infection, pain or hernia of the incision requiring further surgery Need for additional treatment for cancer after surgery Rare (less than 1 in 50)* Recognised (or unrecognised) injury to nearby local structures including blood vessels, spleen, liver, pancreas and bowel which may require conversion to open surgery (or deferred open surgery) Anaesthetic or cardiovascular problems including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death The abnormality in the kidney may subsequently be shown not to be cancer Entry into the lung cavity requiring insertion of a temporary drainage tube. Benefits * See reference at end of booklet. Removal of affected kidney Prevention of future health problems 3
Anaesthetic The operation is performed under general anaesthetic and can last up to 4 hours. Your Hospital Stay Most patients are admitted on the day of their operation, unless specified otherwise. In preparation for your admission please bring with you your regular medications, toiletries and reading material as desired. Visiting times vary from ward to ward, so please check with the staff on arrival to your ward. A member of the nursing staff will see you on arrival at the ward. You will be shown the ward layout and the nurse will be able to answer any questions you may have. Following your operation, your length of stay can be from 2 to 4 nights although, occasionally, some patients stay longer. The day of your operation It will be necessary for you to have an anaesthetic for your operation. Before this you must not eat or drink for a stated period of time and you will be given a nutritional drink to help your body recover more quickly after surgery. You will see an anaesthetist before your operation who will look after you throughout. He/she will discuss the anaesthetic with you and answer any questions you may have. You will be advised which of your regular medications you need to take before surgery. A member of the medical team will ask you to sign your consent form, detailing the operation. They will confirm the side of the operation, which will be marked using a surgical pen. 4
You will be encouraged to shower in the morning of the operation. Shortly before being taken to theatre you will be given a gown to wear. A member of the ward staff will take you to the theatre on your bed. On arrival in the theatre you will be introduced to a member of theatre staff who will ask you to confirm your name and date of birth, checking these details with your medical notes and name bracelet. You will be asked to confirm what operation you are having and the last time you had anything to eat and drink. After your operation Immediately after your operation you will be nursed in the recovery area until the staff are happy for you to return to the general ward. When you wake up, you will have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You may have: Drips (intravenous infusions) to give you fluids until you are eating and drinking again, antibiotics or pain relief. A drain coming out of your side, near your wound to stop blood and tissue fluid collecting around the operation site. A tube into your bladder (urethral catheter) so that your urine output can be measured A small catheter in your back for pain relief (epidural). You will have a blood pressure cuff on your arm when you first wake up and a little clip (called a pulse oximeter) on your finger to measure your pulse and the oxygen levels in your blood. You may also have an oxygen mask on for a while. 5
Your blood pressure will be measured frequently for the first few hours after you come round from the anaesthetic. Your urine output will be monitored very closely at least once an hour at first. You may have some electronic pumps attached to your drips. One of these will be the epidural that will help control your pain. Tell your nurse if you are in pain as the dose can be increased. Pain relief After surgery you will almost certainly have pain for the first week and are bound to need pain relief medication for this period. There are many different pain-relieving drugs you can have. It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of pain relief for you. Pain relief medication works best when you take it regularly, so please do not suffer in silence. You may have an epidural placed during surgery or alternatively be given Patient Controlled Analgesia (PCA) via a drip. Both involve having a button which you can press to release pain relief medication through your drip when required. Do tell your nurse if you need to press the button very often as the dose in the pump may need to be increased. You cannot overdose the machine is set to prevent that. Blood clot prevention You will be provided with stockings to wear before the operation, which you need to keep on for the duration of your stay. You will also be given a small daily injection into your abdomen to try and prevent blood clots in the legs and lungs. These injections will be carried on for 4 weeks following your operation. We like patients to start walking as soon as possible. We also like patients to start walking as soon as possible. 6
Eating and drinking After surgery you will be able to have clear fluids. If tolerated you can then try something like tea or soup before moving on to a normal diet within 1-2 days after surgery. Sugar free chewing gum is recommended for mouth hygiene and to encourage bowel activity. At first, your nurse will keep a very close eye on the amount of urine draining from your catheter. The catheter will most likely be removed the day after surgery. Your wound You will have 3-4 small incisions covered with dressings on your abdomen, and 1 lower down in the groin area. Your stitches will be dissolvable and any clips to the wound should stay in for 10 days. These will be removed by a practice nurse at your local surgery or at home by a district nurse. Getting up Moving about helps you to get better but you will need to start very gradually. The physiotherapist will visit you after your operation to help you get up and about. On the first day following surgery, you will be encouraged to get out of bed, sit in a chair and to walk. Such activity is very important as it helps prevent clots in the legs and chest infections. Nurses will help you with all the drips and drains when moving. With each tube that is removed, you will feel that you are getting back to normal. Gradually you will start to feel better. 7
Discharge Advice Avoid heavy lifting or any strenuous activities You can do normal, non-strenuous, daily activities as you feel able Keep the wound as clean as possible. If it appears red or sore, contact your GP or district/community nurse It is your responsibility to ensure you are fit to drive following your surgery. To are advised to check with your insurance company before driving again. It will be at least 14 days before you heal but it may take several weeks before you feel fully recovered from the surgery. You will be seen in clinic about 4 weeks after surgery to assess your progress. Many patients have persistent twinges of discomfort in the wounds which last for several months. Contact Information If you require any further information, please contact: One of the Urology Nurse Practitioners On 01536 491119 - Urology department or 01536 492000 and ask for these bleep numbers: 649 or 108 References *Information for this leaflet has been referenced from http://www.baus.org.uk/patients/patient+information/kidney If you need this information in another format or language, please telephone 01536 492510. Further information about the Trust is available on the following websites: KGH - www.kgh.nhs.uk NHS Choices - www.nhs.uk Ref: PI 762 February 2018 Review: November 2019