Clinical Conditions

Indications

Patients found to have kidney cancer need to have their kidney removed in order to treat the cancer. Patients with recurrent kidney infections, severe stone disease or long term obstruction of the kidney may develop intractable pain or lose function of the diseased kidney so that nephrectomy is warranted. Finally, over 4,000 people each year in the United States donate one of their two kidneys to a loved one for transplantation.

Standard surgery to remove a kidney requires a flank or abdominal incision of 8 to 20 inches in length. Moreover, in many instances a rib has to be removed to allow adequate exposure. Most of these procedures may be performed by laparoscopy with similar success rates using small "key hole" incisions.

Procedure

The patient must undergo general anesthesia for this procedure. Four to five small cylindrical tubes called trocars are placed into the abdominal cavity. The trocars allow entry of a video-telescope, called a laparoscope, to view the entire abdominal cavity and kidney. The video-telescope gives the surgeon a magnified view of the operating field and allows identification of vessels and structures with more clarity than is possible in open surgery. Accessory small trocars allow the introduction of fine instruments necessary to perform surgery. With all the trocars and instruments in place the vessels which bring blood to and from the kidney are clipped as well as the ureter. The kidney is then freed from all of its surrounding structures. The kidney is placed into a bag within the body and removed by enlarging one of the trocar incisions approximately 2 inches.

Results

Several investigators, including our group, have compared laparoscopic nephrectomies to standard open nephrectomies in terms of time of surgery, blood loss, pain medication requirements, length of hospital stay, time to return to normal activity and complications. The results show that operating time is slightly longer by laparoscopy. However, the amount of pain medication required, time in the hospital and time to return to work is significantly shorter for these patients. The cosmetic results are better for patients treated by laparoscopy. In addition, the complication rates and blood loss was similar in both groups.