Laparoscopic Kidney Cyst Ablation is a minimally invasive
surgical technique, which provides patients with less discomfort
and equivalent results when compared to the traditional open surgery.
Laparoscopic Kidney Cyst Ablation provides a safe and effective
way to remove symptomatic kidney cysts for patients that experience
flank pain, abdominal pain or have a obstructed kidney due to kidney
cysts while preserving the remainder of the kidney.
When compared to the conventional open surgical technique, laparoscopic
cyst ablation has resulted in significantly less post-operative
pain, a shorter hospital stay, earlier return to work and daily
activities, a more favorable cosmetic result and outcomes that appear
to be identical to that of open surgery. Laparoscopic Kidney Cyst
Ablation has become a standard procedure for select patients with
symptomatic renal cysts.
Johns Hopkins Hospital Patients please
use the phone numbers listed above.
In the event of an emergency and you need to contact someone in the evening hours
or on the weekend, please call the paging operator at 410-955-6070 (for
Johns Hopkins Hospital Patients) and ask to speak to the urologist
For directions to Johns Hopkins
PRIOR TO THE SURGERY
During your initial consultation with your
surgeon, he will review your medical history as well as any
outside reports, records, and outside Xray films (e.g. CT
scan, MRI, sonogram). A brief physical examination will also
be performed at the time of your visit. If your surgeon determines
that you are a candidate for surgery, you will then meet with
a Patient Service Surgery Coordinator to arrange for the date
of your operation.
NOTE: It is very important
that you gather and bring ALL of your Xray films and
REPORTS to your initial consultation with your surgeon.
What to expect prior to the surgery
Since insurance companies will not permit patients to be admitted
to the hospital the day before surgery to have tests completed,
you must make an appointment to have pre-operative testing
done at your family doctor or primary care physician's office
within 1 month prior to the date of surgery.
For Johns Hopkins Hospital Patients: These results need to be faxed by your doctor's
office to the Pre-operative Evaluation Center at
443-287-9358 two weeks prior to your
surgery. Please call The Documentation Center at 410-955-9453
two weeks before your surgery date to confirm that this information
Once your surgical date is secured, you will receive a form
along with a letter of explanation to take to your primary
care physician or family doctor in order to have the following
pre-operative testing done prior to your surgery.
• Aspirin, Motrin, Ibuprofen, Advil,
Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex,
Voltaren, Vioxx, Plavix and some other arthritis medications
can cause bleeding and should be avoided 1 week
prior to the date of surgery (Please contact your
surgeon’s office if you are unsure about which medications
to stop prior to surgery. Do not stop any medication without
contacting the prescribing doctor to get their approval).
Bowel Preparation and Clear Liquid
Do not eat or drink anything after midnight the night before
the surgery and drink one bottle of Magnesium Citrate (can
be purchased at your local pharmacy) the evening before
Drink only clear fluids for a 24-hour
period prior to the date of your surgery. Clear liquids
are liquids that you are able to see through. Please follow
the diet below.
Clear Liquid Diet
Remember not to eat or drink anything after
midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through.
Please follow the diet below.
Clear Broths (no cream soups, meat,
Juices (no orange juice or tomato
Apple juice or apple cider
Tea (you may add sweetener, but no cream
Coffee (you may add sweetener, but no
cream or milk)
Clear Jello (without fruit)
Popsicles (without fruit or cream)
Italian ices or snowball (no marshmallow)
Laparoscopic Kidney Cyst Ablation is performed
under a general anesthetic. The typical length of the operation
is 3-4 hours. The surgery is performed through 3 - 4 small
(1cm) incisions made in the abdomen. A telescope and small
instruments are inserted into the abdomen through these keyhole
incisions, which allow the surgeon to completely dissect free
and excise the relevant kidney cyst(s) without having to place
his hands into the abdomen.
A step by step description
of the procedure is shown in the slide show below:
The following is a series
of video clips that demonstrate key steps of a laparoscopic
nephrectomy for removal of a left kidney tumor.
these video clips include footage from an actual surgery which
some viewers may find difficult to watch.
Potential Risks and Complications
Although this procedure has proven to be
very safe, as in any surgical procedure there are risks and
potential complications. The safety and complication rates
are similar when compared to the open surgery. Potential risks
Bleeding: Blood loss during this procedure
is typically minor and a transfusion is needed in less than
5% of patients. If you are interested in autologous blood
transfusion (donating your own blood) prior to your surgery,
you must make your surgeon aware. When the packet of information
is mailed or given to you regarding your surgery, you will
receive an authorization form for you to take to the Red
Cross in your area.
Infection: All patients are treated
with intravenous antibiotics, prior to starting surgery
to decrease the chance of infection from occurring after
surgery. If you develop any signs or symptoms of infection
after the surgery (fever, drainage from your incisions,
urinary frequency/discomfort, pain or anything that you
may be concerned about) please contact us at once.
Tissue / Organ Injury: Although uncommon,
possible injury to surrounding tissue and organs including
bowel, vascular structures, spleen, liver, pancreas and
gallbladder could require further surgery. Scar tissue may
also form in the kidney requiring further surgery. Injury
could occur to nerves or muscles related to positioning
on the operating table
Hernia: Hernias at incision sites rarely
occur since all keyhole incisions are closed carefully at
the completion of your surgery
Conversion to Open Surgery: The surgical
procedure may require conversion to the standard open operation
if difficulty is encountered during the laparoscopic procedure.
This could result in a larger than standard open incision
and possibly a longer recuperation period.
Urine Leak: If the urinary collecting
system of the kidney is injured or needs to be cut across
in order to remove the kidney cyst, it is usually sutured
closed. If urine leaks out of this hole, you may need to
have an internal drainage tube (ureteral stent) to help
seal the leakage. On rare occasion you may require additional
WHAT TO EXPECT AFTER
During your hospitalization
Immediately after the surgery you will be
taken to the recovery room and transferred to your hospital
room once you are fully awake and your vital signs are stable.
Postoperative Pain: Pain medication
can be controlled and delivered by the patient via an intravenous
patient-controlled analgesia (PCA) pump or by injection
(pain shot) administered by the nursing staff. You may experience
some minor transient shoulder pain (1-2 days) related to
the carbon dioxide gas used to inflate your abdomen during
the laparoscopic surgery.
Drain: You can expect to have a small
drain coming out of an incision in your back over the kidney
area for approximately 1 - 2 days. The fluid from the drain
will often appear blood-tinged. If persistent drainage occurs,
you may have to go home with the drain and have it removed
in your doctor's office.
Stent: You may have a plastic internal
ureteral stent in place located between the kidney and the
bladder to promote drainage from the kidney.
Nausea: You may experience some nausea
related to the anesthesia. Medication is available to treat
Urinary Catheter:You can expect to have
a urinary catheter draining your bladder (which is placed
in the operating room while the patient is asleep) for approximately
1 - 2 days after the surgery. It is not uncommon to have
blood-tinged urine for a few days after your surgery.
Diet: You can expect to have an intravenous
catheter (IV) in for 1-2 days. (AnIV is a small tube placed
into your vein so that you can receive necessary fluids
and stay well hydrated; in addition it provides a way to
receive medication.) Most patients are able to tolerate
ice chips and small sips of liquids the day of the surgery
and regular food the next day. Once on a regular diet, pain
medication will be taken by mouth instead of by IV or shot.
Fatigue: Fatigue is common and should
start to subside in a few weeks following surgery.
Incentive Spirometry: You will be expected
to do some very simple breathing exercises to help prevent
respiratory infections through using an incentive spirometry
device (these exercises will be explained to you by the
nursing staff during your hospital stay). Coughing and deep
breathing is an important part of your recuperation and
helps prevent pneumonia and other pulmonary complications.
Ambulation: On the day of surgery it
is very important to get out of bed and begin walking with
the supervision of your nurse or family member to help prevent
blood clots from forming in your legs. You can also expect
to have SCD's (sequential compression devices) along with
tight white stockings on your legs to prevent blood clots
from forming in your legs.
Hospital Stay: The length of hospital
stay for most patients is approximately 2 days.
Constipation/Gas Cramps: You may experience
sluggish bowels for several days or several weeks. Suppositories
and stool softeners are usually given to help with this
problem. Taking mineral oil daily at home will also help
to prevent constipation. Narcotic pain medication can also
cause constipation and therefore patients are encouraged
to discontinue any narcotic pain medication as soon after
surgery as tolerated.
What to expect after discharge
from the hospital
Pain Control: You can expect to have
some pain that may require pain medication for a few days
after discharge, and then Tylenol should be sufficient to
control your pain.
Showering: You may shower after returning
home from the hospital. Your wound sites can get wet, but
must be padded dry immediately after showering. Tub baths
are not recommended in the first 2 weeks after surgery as
this will soak your incisions and increase the risk of infection..
You may have adhesive strips across your incision. These
are not to be removed. They will fall off in approximately
5-7 days. Sutures will dissolve in 4-6 weeks.
Activity: Taking daily walks are strongly
advised. Prolonged sitting or lying in bed should be avoided.
Climbing stairs is possible, but should be taken slowly.
Driving should be avoided for at least 1-2 weeks after surgery.
Absolutely no heavy lifting (greater than 20 pounds) or
exercising (jogging, swimming, treadmill, biking) for six
weeks or until instructed by your doctor. Most patients
return to full activity on an average of 3 weeks after surgery.
You can expect to return to work in approximately 4 weeks.
Diet: You should drink plenty of fluids
and discuss with your doctor if you need to be on a salt
or protein restricted diet.
Follow-up Appointment: If your surgery
was performed at Johns Hopkins Hospital, you will need to
call the Johns Hopkins Out Patient Urology Clinic at 410-955-6707
after your surgery date to schedule a follow up appointment
as instructed by your surgeon.
Pathology Results: The pathology results
from your surgery are usually available in one week following
surgery. You may discuss these results with your surgeon
by contacting him by phone or in your followup appointment
in the office.
Kidney Function Blood Tests and Xrays: Patients
are encouraged to have an annual blood test, called serum
creatinine, performed by their primary care physician to
follow their kidney function. Your surgeon will also review
these results in the office during follow up visits. Follow
up Xray tests (e.g. CT, MRI, sonograms) may be periodically
Ureteral Stent Removal: If a ureteral
stent is placed during your surgery, the length of the time
the stent remains in place is variable. Your doctor will
typically request for it to be removed within a 2-6 week
period. This can be removed in your doctor's office. It
is common to feel a slight amount of flank fullness and
urgency to void while the stent is in place, however, these
symptoms often improve over time. The severity and duration
of the symptoms is highly variable and will resolve when
the stent is removed. It is critical that patients return
to have their stent removed as instructed by their physician
as a prolonged indwelling ureteral stent can result in encrustation
by stone debris, infection, and obstruction of the kidney.