What does the procedure involve?
This involves removal of part of the kidney with the surrounding fat for suspected cancer of the kidney. It involves the placement of a robotically controlled telescope and operating instruments into your abdominal cavity using 4-5 small incisions (sometimes referred to as “keyholes”). One incision will need to be enlarged to extract the tissue being removed.
What are the alternatives to this procedure?
Observation, total nephrectomy, open surgery or standard laparoscopic keyhole surgery without the use of the robot. For some smaller tumours, tumour destruction using radio-frequency ablation may be an option but will usually have been considered before the decision to offer you 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 da Vinci® robot used in this operation utilises a high-magnification 3-D camera to allow the surgeon to see inside your abdomen, and three robotic arms which can hold various instruments. These instruments allow the surgeon to carry out your operation very precisely. They are approximately 8mm in width and have a greater range of movement than the human hand and, because of their size, they allow the surgeon to carry out the operation using 3-D vision in a small space. The robot does not, of course, do the operation and cannot work on its own.
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 remain in place for 2 days usually; sometimes the doctors will decide to leave it longer if there is bleeding or 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
- Bleeding requiring blood transfusion or conversion to open surgery
- Urinary leak from the cut edge of the kidney requiring further treatment or insertion of a ureteric stent
Occasional (between 1 in 10 and 1 in 50)
- Infection, pain or hernia at the incision site requiring further treatment
- Total removal of the kidney may need to be performed if partial removal is not thought to be possible
- Delayed bleeding from the kidney developing 7-21 days after surgery, typically after discharge home (see section below, “What should I expect when I get home”)
Rare (less than 1 in 50)
- Entry into lung cavity requiring insertion of a temporary drain
- The histological abnormality may eventually turn out not to be cancer
- Recognised (or unrecognised) injury to organs/blood vessels requiring conversion to open surgery (or deferred open surgery)
- Involvement or injury to nearby local structures (blood vessels, spleen, liver, kidney, lung, pancreas, bowel) requiring more extensive surgery
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)
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.
There is a very low risk that you could develop late bleeding as a result of this surgery, typically presenting as blood in the urine or increasing abdominal pain 7-21 days after surgery. This may require emergency intervention and if you develop these symptoms you should contact Professor Vale’s emergency number.