Laparoscopic radical removal of the kidney and ureter

What is this?

This involves removal of the kidney (and surrounding fat) for suspected cancer of the kidney. It requires the placement of operating instruments into your abdominal cavity using 4-5 small incisions. The lower ureter is removed at the same procedure

What alternatives are there?

Observation, radiotherapy, chemotherapy, open surgery

What to expect before procedure

You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. The kidney and most of the ureter are usually dissected free through several keyhole incisions. The lower ureter is disconnected either using a telescope through the bladder or with a separate incision into the lower abdomen A bladder catheter is normally inserted post-operatively, to monitor urine output, and a drainage tube is usually placed through the skin into the bed of the kidney.

After the procedure

You will be given fluids to drink from an early stage after the operation and you will be encouraged to mobilise early to prevent blood clots in the veins of your legs. The wound drain will need to remain in place for up to 1 week in case urine leaks from the cut surface of the bladder. The average hospital stay is 7 days.

Potential side effects