Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy)
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; radical nephrectomy
Common name(s): Laparoscopic radical nephrectomy, Laparoscopic kidney removal
Medical term: Radical nephrectomy (includes removal of Gerota's fascia, surrounding fatty tissue, regional lymph nodes, and adrenalectomy).
Summary
A laparoscopic radical nephrectomy is a minimally invasive surgical procedure to remove an entire kidney, its surrounding fatty tissue, lymph nodes, and sometimes the adrenal gland. It is performed using small incisions and a camera to guide the surgery.
Purpose
Medical Condition: This procedure addresses kidney cancer or severe damage to the kidney. Goals: The aim is to remove cancerous or damaged kidney tissue to prevent the spread of cancer or alleviate symptoms caused by kidney malfunction.
Indications
Symptoms or Conditions: This procedure is indicated for patients with renal cell carcinoma, extensive kidney damage, large kidney tumors, or non-functioning kidneys due to chronic disease. Patient Criteria: Suitable for individuals diagnosed with localized kidney cancer, patients with overall good health, or those who have not responded well to other treatments.
Preparation
Pre-procedure Instructions:
- Fasting for at least 8 hours before the surgery, usually starting at midnight.
- Adjust or stop certain medications as advised by your doctor.
- Arranging for someone to drive you home post-procedure. Diagnostic Tests:
- Blood tests, urine tests, CT scans, or MRIs to assess kidney function and the extent of the disease.
- Pre-operative clearance by your primary care physician or specialist.
Procedure Description
- Anesthesia: General anesthesia will be administered to ensure you are asleep and pain-free during the surgery.
- Incisions: Several small incisions are made in the abdominal area.
- Insertion of Tools: A laparoscope (camera) and other surgical instruments are inserted through these incisions.
- Visualization: The laparoscope transmits images to a monitor, allowing the surgeon to see inside your abdomen.
- Dissection: The kidney, along with Gerota's fascia, surrounding fatty tissue, regional lymph nodes, and adrenal gland (if necessary), is carefully dissected and detached.
- Removal: The kidney and other tissues are removed through one of the incisions.
- Closure: Incisions are closed using sutures or staples, and a dressing is applied.
Duration
The procedure typically takes 3 to 4 hours.
Setting
This surgery is performed in a hospital operating room or a specialized surgical center.
Personnel
The surgery involves:
- A surgeon (urologist or general surgeon).
- An anesthesiologist.
- Nurses and surgical technologists.
Risks and Complications
Common Risks:
- Bleeding
- Infection at the incision sites
- Injury to surrounding organs Rare Risks:
- Blood clots
- Pneumonia
- Anesthetic complications Management: Risks are managed through careful surgical technique, prophylactic antibiotics, anticoagulants, and close post-operative monitoring.
Benefits
Expected Benefits:
- Removal of cancerous tissue, potentially curing kidney cancer.
- Relief from symptoms of a non-functional kidney. Realization: Benefits are typically realized within weeks to months post-surgery as recovery progresses.
Recovery
Post-procedure Care:
- Pain management through medications.
- Instructions on wound care and activity restrictions.
- Gradual return to regular activities as advised by the surgeon. Recovery Time: Typically 4 to 6 weeks with follow-up appointments to monitor healing and kidney function.
Alternatives
Other Treatment Options:
- Partial nephrectomy: Removing only the tumor and sparing the rest of the kidney.
- Non-surgical options: Such as ablation or radiation therapy, particularly for patients unable to undergo surgery. Pros and Cons: Alternatives may be less invasive but may not be as effective for extensive cancer or damage.
Patient Experience
During the Procedure:
- Under general anesthesia, you will not feel or remember anything. After the Procedure:
- Soreness and discomfort managed with medications.
- Gradual return to normal activities with some temporary restrictions.
- Possible need for physical therapy or assistance at home. Pain Management: Post-operative pain is managed with prescribed pain relievers and comfort measures like ice packs and rest.
This markdown text provides a comprehensive yet concise overview of the procedure, formatted appropriately with headings and bullet points for clarity.