For Patients Needing Kidney Removal, Laparoscopic Procedure Now An Option

Within the last 10 years, minimally invasive surgery, also known as “keyhole” or “band-aid” surgery, has become an alternative to traditional “open” surgeries for many different procedures.  From removing gallstones, to orthopedic and plastic surgery, nearly every organ in the human body is accessible to a surgeon’s camera and scalpel.

Unlike traditional surgeries, which sometimes require long, deep incisions, minimally invasive surgery is performed using small incisions.  A thin instrument with a camera on the end (called a laparoscope or endoscope) is then inserted along with miniaturized graspers and scissors to perform the operation.  The surgeon operates by watching a video display.  

One of the newer types of surgery to be done laparascopically is kidney removal, also called nephrectomy.  Unlike the open surgery, which involves a large incision along the rib cage and may involve the removal of a rib, a laparoscopic nephrectomy requires 3 or 4 small incisions – usually no more than an inch each – in the abdomen and flank and may include one somewhat larger incision to permit removal of an intact kidney. 

Until 2001, open surgery was the only option for patients who needed to have their kidney removed.  But an international study presented at that year’s American Urological Association confirmed that outcomes for patients who had the laparoscopic procedure were similar to those who had the traditional open surgery. There are several advantages to minimally invasive surgeries.  Since the overall trauma to the skin and muscles is reduced, post-operative pain may be less, which may allow patients to get out of bed sooner.  They may be able to walk and move around within hours of their operation, where recovery time for traditional surgeries can last weeks or months.  Also, minimally invasive surgeries can have a reduced infection rate because the body’s tissues are not exposed to the open air for long periods of time as they are in traditional surgery.

Current data indicate that open and laparoscopic radical nephrectomies have similar complication rates and provide equally effective cancer treatment for patients with tumors that are localized.  Compared to open radical nephrectomy, laparoscopic radical nephrectomy has less postoperative pain, a shorter hospital stay and a shorter recovery time.

Dr. Richard Still, III, a urologist with Des Peres Hospital, says “This type of procedure is recommended for patients with localized tumors and who have minimal scar tissue around the kidney or in the general surgical area.”

If you elect to undergo a laparoscopic radical nephrectomy, there is a low risk (usually less than five percent) that the surgeon will need to convert to an open nephrectomy (i.e., convert the "key hole" incisions to a much larger incision).  Not all patients are candidates for laparoscopic nephrectomy.  Laparoscopic radical nephrectomy is best suited for small, localized tumors that have not invaded the lymph nodes or renal vein.

No matter what type of surgery you require, whether it is traditional or minimally invasive, be sure to discuss all of your options and concerns with your health care provider and follow the advice and guidelines they set forth.

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