Lapraoscopic Radical Nephro-Ureterectomy (Removal of the Kidney and Ureter)

What does the procedure involve?

This involves removal of the kidney through several keyhole incisions. It requires the placement of a telescope and operating instruments into your abdominal cavity using 4-5 small incisions. The adrenal gland may also be removed and one incision will need to be enlarged to remove the kidney. The lower ureter is removed at the same procedure.

What are the alternatives to this procedure?

Observation, radiotherapy, chemotherapy, open surgery

What should I expect before the procedure?

Please be sure to inform Professor Vale in advance of your surgery if you have any of the following:

  • an artificial heart valve
  • a coronary artery stent
  • a heart pacemaker or defibrillator
  • an artificial joint
  • an artificial blood vessel graft
  • a neurosurgical shunt
  • any other implanted foreign body
  • a regular prescription for Warfarin, Aspirin or Clopidogrel (Plavix®) (blood thinners)
  • a previous or current MRSA infection

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 or spinal anaesthetic which minimises pain post-operatively.

A bladder catheter is normally inserted during the operation to monitor urine output and a drainage tube is usually placed through the skin into the bed of the kidney.

The kidney and most of the ureter are usually dissected free through several keyhole incisions. The lower ureter is disconnected from the bladder with a separate incision into the lower abdomen; this incision is used to remove the kidney and ureter as one specimen for pathology.

What happens immediately 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.

The wound drain will need to remain in place for up to 3 days in case urine leaks from the cut surface of the bladder. The urinary catheter will need to remain in place for 10-14 days to allow the bladder to heal and minimise the risk of a urine leak. The average hospital stay is 4 days.

Are there any side-effects?

Common (greater than 1 in 10)

  • Temporary shoulder tip pain
  • Temporary abdominal bloating
  • Recurrence of disease elsewhere in the urinary tract which requires regular telescopic examinations of the bladder for follow-up

Occasional (between 1 in 10 and 1 in 50)

  • Bleeding, infection, pain or hernia at the incision site requiring further surgery
  • Need for additional treatment for cancer after surgery

Rare (less than 1 in 50)

  • Entry into the lung cavity requiring insertion of a temporary drainage tube
  • Recognised (or unrecognised) injury to organs/blood vessels requiring

conversion to open surgery (or deferred open surgery)

  • Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)
  • The histological abnormality in the kidney may subsequently be shown not to be cancer
  • Persistent urine leakage from the bladder requiring prolonged catheterisation or further surgery
  • Dialysis may be required to stabilise your kidney function if your other kidney functions poorly

What should I expect when I get home?

There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers. All the wounds are closed with absorbable stitches which do not require removal.

It will take 10-14 days to recover fully from the procedure and most people can return to normal activities after 2-6 weeks. However you should refrain from heavy lifting and abdominal exercises for a minimum of 6 weeks to allow the muscle layers to heal fully.

Catheter removal

Before your discharge, arrangements will be made for you to return to the out-patient department for removal of your urinary catheter. Usually you will undergo a special cystogram X-ray immediately before catheter removal. This is a painless procedure in which one of the Radiology doctors injects X-ray contrast through the catheter to partially fill the bladder to check there is no leak. Assuming there is no leak of urine the catheter can be removed. In the rare event where a leak is seen, the catheter will need to remain for longer until the leak is healed. This would be discussed with you at the time and arrangements made for a repeat cystogram 7-10 days later.