Laparoscopic radical nephrectomy

Laparoscopic radical nephrectomy is used to surgically treat large kidney tumors. The aim of this procedure is to remove the kidney affected by the tumor from the anterior renal fascia (also called Gerota’s fascia), a layer of connective tissue that separates the adipose capsule of kindey and the pararenal fat. Although the tumor size is normally listed as 7 cm, the actual size isn’t the only deciding factor on whether to remove the kidney in its entirety, or to perform a partial nephrectomy. It is necessary to analyze the anatomic conditions of the tumor, the blood vessels, and the renal collecting system of each and every patient individually.

How is it performed?

In order to perform laparoscopic radical nephrectomy, we require 3-4 trocars inserted through the left or the right side of the abdomen. When done extraperitoneally with balloon dilation, an artificial space is made in front of the peritoneum, and trocars are inserted there. When done transperitoneally, the trocars are inserted into the abdomen itself. After detaching the colon and opening the parietal peritoneum above the affected kidney, the lower pole of the kidney is identified and the dissection of renal hilum is made, in order to precisely prepare the blood vessels and ureter, which are closed using special clips as far from the kidney as possible. The procedure is completed by resection of the entire kidney and the surrounding fatty tissue. The removed kidney with the tumor is inserted in an endoscopic bag. Then, a drainage tube is inserted in order to monitor and control possible post-operative bleeding. The endoscopic bag is removed through an extended incision made in the best spot of the muscle wall to avoid cutting muscle. The remaining trocars are removed, and the incisions are stitched up.

What are the possible complications?

In the hands of an experienced surgical team, complications in laparoscopic radical nephrectomies are rare. The most common possible complication is bleeding that might require a blood transfusion. There are also general risks of laparoscopic surgery, such as the damage of stomach organs. However, these risks are minimal and occur in less than 1% of all patients. Approximately less than 3% of laparoscopic radical nephrectomies require a conversion to the open surgical approach.