50548 Laparoscopy, surgical; nephrectomy with total ureterectomy

Name of the Procedure:

Laparoscopy, surgical; nephrectomy with total ureterectomy
Common names: Laparoscopic nephroureterectomy, keyhole kidney and ureter removal

Summary

Laparoscopic nephrectomy with total ureterectomy is a minimally invasive surgical procedure to remove a kidney and its entire ureter using small incisions and a camera-assisted device.

Purpose

The procedure addresses conditions such as kidney cancer, chronic infection, or severe kidney damage. The goal is to remove the diseased or damaged kidney and ureter while minimizing patient recovery time and discomfort typically associated with open surgery.

Indications

• Kidney cancer
• Severe kidney infection or damage
• Large kidney stones causing irreversible damage

• Congenital abnormalities causing obstruction or infection

  Patient factors making the procedure appropriate:

• Good general health
• Absence of widespread metastasis (in cancer cases)
• Nephrological indications confirmed through imaging and lab tests

Preparation

• Fasting 8-12 hours before surgery
• Stopping blood-thinning medications several days prior
• Pre-operative imaging tests like CT scans or MRIs
• Blood and urine tests

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) is inserted through one incision to provide a visual guide.
4. Surgical instruments are inserted through other incisions to cut and remove the kidney and ureter.
5. The kidney and ureter are carefully extracted through an incision.
6. The incisions are closed with sutures or surgical staples.

Duration

Typically, 3-4 hours.

Setting

Performed in a hospital operating room or specialized surgical center.

Personnel

• Lead surgeon (urologist specialized in laparoscopic techniques)
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

Common risks:

• Bleeding
• Infection
• Reaction to anesthesia Rare complications:
• Injury to surrounding organs
• Blood clots
• Hernia at the incision site

Benefits

• Reduced post-operative pain compared to open surgery
• Shorter hospital stay (typically 1-3 days)
• Faster return to normal activities (within 2-4 weeks)
• Smaller scars

Recovery

• Pain management includes oral pain relievers and early mobilization.
• Instructions on wound care are given.
• Typical recovery time is 2-4 weeks, with some restrictions on heavy lifting and strenuous activity.
• Follow-up appointments for wound check and imaging tests to ensure no recurrence of disease.

Alternatives

• Open nephrectomy (larger incision, longer recovery)
• Partial nephrectomy (if only part of the kidney is affected)
• Non-surgical options like chemotherapy or radiation (specific to cancer cases, less definitive than surgery)

Pros and cons of alternatives:

• Open nephrectomy allows for more direct access but has a longer recovery.
• Partial nephrectomy preserves kidney function but is not suitable for widespread disease.
• Non-surgical options might be less invasive but typically are less effective in complete disease removal.

Patient Experience

During the procedure, the patient is under general anesthesia and feels no pain. Post-surgery, patients might experience discomfort or pain at the incision sites, which is managed with medication. Early mobilization and breathing exercises are encouraged to aid recovery. Emotional reassurance and support are usually needed to navigate the recovery phase.