Thyer Urology

The kidney is a paired organ in the upper abdomen that filters the blood of waste then excretes this filtered waste in the form of urine. The urine is transported from the kidney via the ureter to the bladder in the pelvis where it is stored.

Laparoscopic Nephrectomy is the term used to describe keyhole removal of the entire kidney.

Mr Thyer may recommend laparoscopic nephrectomy for:

1. A large kidney tumour
2. A small kidney tumour in a position that is not suitable for partial nephrectomy
3. A poorly-functioning kidney causing symptoms of pain or urinary infections

Pre operation

Ten days prior to the procedure you should:

• Have your blood and urine test
• Notify Mr Thyer’s rooms if you are taking any blood thinning medication

The procedure

On arrival at hospital you will be prepared for theatre by nursing staff. Mr Thyer will see you just prior to being taken into the operating theatre. You will require a general anaesthetic of approximately 2 hours. Mr Thyer will make a series of 3-4 small incisions in the abdomen to allow the passage of the laparoscopic instruments. The kidney will be dissected free from its surrounding structures and the blood vessels and ureter clipped and divided. The kidney will be removed via a small incision in the lower abdomen and sent to a pathologist for microscopic examination (you may incur a pathologist fee). After the operation a drain may be left in the abdomen and a catheter in the bladder. Most people are in hospital 1-2 nights then discharged home after Mr Thyer’s review.

Risks

• Bleeding. Bleeding from the operation site is very rare but if occurs may necessitate a return to theate.
• Infection. Wound infection is rare but may require a course of oral antibiotics to correct.
• Conversion to open nephrectomy. Occasionally a kidney is more difficult to dissect free than anticipated using the laparoscopic technique and conversion to open approach is required.
• Injury to surrounding structures. The bowel, liver, spleen, adrenal, pancreas and large blood vessels are close to the kidney and may require repair if injured during the dissection.
• Cancer recurrence. Following laparoscopic nephrectomy it is unusual to see cancer recurrence however Mr Thyer will undertake 6 monthly CT or ultrasound imaging for 3-5 years to check for recurrence.
• Chronic renal impairment. Most people have no trouble living with one kidney but occasionally the remaining kidney can struggle to function adequately and input from a renal physician may be required.
• Hernia. Very occasionally (1%) a hernia can develop at the kidney extraction site which requires correction with a general surgeon.
• There are risks with any general anaesthetic which are very rare including blood clots, heart or lung problems and adverse drug reactions. The anaesthetist will discuss these with you at the time of the procedure.

Follow up

Mr Thyer’s rooms will contact you to arrange follow up to check your progress, wounds and pathology 2-3 weeks following the operation. You should take laxatives, wear compression stockings, drink plenty of water and avoid heavy lifting for 3 weeks following the procedure. You should not drive a motor vehicle until seen by Mr Thyer at the follow up appointment.

When to contact Mr Thyer

Following the procedure, you should contact Mr Thyer if you:

• Have a fever over 38 Degrees
• Are unable to pass urine
• Have not received a follow up appointment
• You can contact Mr Thyer via his rooms during working hours or after hours via the after hours nurse at Hollywood Hospital on (08) 9346 6000
• You can attend the emergency department at the hospital at which you had your procedure. (Hollywood Private Emergency Department charge a fee for attendance).