Laparoscopic Partial Nephrectomy provides patients with a safe and
effective way to remove a small renal tumor, while preserving the
remainder of the kidney. This is a minimally invasive technique,
which provides patients with less discomfort and equivalent results
when compared to the traditional open surgery.
When compared to the conventional open surgical technique, laparoscopic
partial nephrectomy 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. Partial nephrectomy has
become a standard procedure for select patients with renal cell
carcinoma (esp. small < 4cm, peripherally located tumors). The
results of partial nephrectomy are less satisfactory in patients
with larger renal cell carcinomas, leaving radical nephrectomy (removing
the entire kidney) as the standard approach.
Johns Hopkins Hospital Patients and Johns Hopkins Bayview Medical
Center Patients please use the phone numbers listed above
For directions to Johns Hopkins
Hospital and Bayview Medical Center please click
PRIOR TO THE SURGERY
What to expect during you preoperative
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
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
For Johns Hopkins Bayview Medical Center Patients
: These results need to be faxed by your doctor's office to
the Pre-operative Evaluation Center at 410-550-1391
one week prior to your surgery. Please call The Documentation
Center at 410-550-2495
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.
- Physical exam
- EKG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel (blood
Medications to Avoid Prior to 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 your surgery.
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
- Grape juice
- Cranberry juice
- Hawaiian punch
- Kool Aid
- Gator Aid
- 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 partial nephrectomy is performed
under a general anesthetic. The typical length of the operation
is 3-4 hours. The surgery is performed through 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 free and dissect the
tumor without having to place his hands into the abdomen.
The defect in the kidney is then sewn closed with sutures
and a special sealant glue. The tumor is then placed within
a plastic sack and removed intact through an extension of
one of the existing incision sites.
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
- 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 needs to be
cut across in order to remove the kidney tumor, it is usually
sutured closed. If urine leaks out of this hole, you may
need to have an internal drainage tube (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 2 days. This
will drain blood tinged fluid and urine. If persistent drainage
occurs, you may have to go home with the drain and have
it removed in your doctor's office.
- Ureteral Stent: You
may have a plastic internal ureteral stent in place located
between the kidney and the bladder to promote drainage from
the kidney. This may remain in place for 2 to 6 weeks.
- Nausea: You may experience
some nausea related to the anesthesia. Medication is available
to treat persistent nausea.
- 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 two 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. (An
IV 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
- 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
- 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
- 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. If your surgery is performed
at Johns Hopkins Bayview Medical Center please call 410-550-7008
to schedule a follow up appointment.
- 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 overall kidney function.
Your surgeon will also review these results in the office
during follow up visits. In patients with kidney tumors,
followup Xray tests (e.g. CT, MRI, sonograms) may be periodically
required to follow the appearance of your remaining kidney.
- 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.