Laparoscopic Nephrectomy

Laparoscopic nephrectomy is a surgical procedure that involves the removal of a kidney through several small incisions, rather than through a large open incision.

Dr Png Keng Siang
Dr Png Keng Siang
Senior Consultant Urologist & Robotic Surgeon

What is Laparoscopic Nephrectomy?

Laparoscopic nephrectomy is a surgical procedure that is performed through several small incisions, typically in the flank area—between the ribs and the hip. Known as keyhole surgery, it involves the use of specialised instruments and a laparoscope. This device is a thin tube equipped with a light and a camera, allowing the urologist to view the kidney on a monitor and perform the procedure with greater precision.

Indications for Laparoscopic Nephrectomy

Laparoscopic nephrectomy is indicated for various conditions affecting kidney function and overall health. The most common indications include:

Kidney Cancer

Often performed to remove renal cell carcinoma, the most common type of kidney cancer, especially when the tumour is confined to the kidney and has not spread to surrounding tissues.

Benign Kidney Tumours

This procedure is used to remove non-cancerous growths that may be causing symptoms or have the potential to become malignant.

Chronic Kidney Disease

This technique is applied in cases where the kidney has sustained irreversible damage due to conditions like hypertension or diabetes, leading to a significant decline in renal function.

Obstructive Pathologies

Employed to alleviate conditions such as ureteropelvic junction obstruction, which can cause severe pain and swelling due to the blockage of urine flow.

Benefits and Risks of Laparoscopic Nephrectomy

Less Postoperative Pain: Smaller incisions result in less pain after surgery than open nephrectomy.

Quicker Recovery: Patients typically experience a faster return to normal activities.

Shorter Hospital Stay: The minimally invasive nature of the surgery often results in shorter hospital stays.

Reduced Scarring: Due to the smaller incisions, scarring is significantly reduced.

Lower Risk of Infection: Smaller wounds are generally associated with a lower risk of postoperative infections.

Bleeding: As with any surgical procedure, there is a risk of bleeding, although it is typically less than with open surgery.

Infection: Infections can still occur despite a lower risk than open surgery.

Injury to Surrounding Organs: There is a risk of accidental damage to surrounding organs such as the intestines, liver, or spleen.

Conversion to Open Surgery: In some cases, complications may necessitate converting the laparoscopic procedure to an open surgery.

Anaesthesia Risks: Like all surgeries requiring general anaesthesia, there are risks associated with it.

Preoperative Preparation

Preoperative preparation for laparoscopic nephrectomy is important for a successful surgery and recovery. It involves several steps to prepare the patient physically and mentally for the procedure:

Medical Evaluation

Comprehensive assessment to check the patient’s overall health, including routine blood tests, imaging studies like CT scans or MRIs, and sometimes cardiac testing to assess fitness for anaesthesia.

Medication Review

Discuss current medications with the urologist or anesthesiologist to determine which should be continued or temporarily stopped.

Fasting

Patients are typically required to fast for at least 6 to 12 hours before surgery to reduce the risk of aspiration during anaesthesia.

Bowel Preparation

Depending on the surgical approach and their cases, some patients may need bowel preparation to clear the intestines.

Preoperative Instructions

Patients receive detailed instructions regarding the cessation of eating and drinking, medication adjustments, and what to bring on the day of surgery.

The Laparoscopic Nephrectomy Procedure

The laparoscopic nephrectomy procedure is a detailed and carefully coordinated surgical process that involves several key steps:

The patient is placed under general anaesthesia to ensure they are unconscious and pain-free throughout the procedure.

The patient is carefully positioned to provide optimal access to the kidney. This usually involves lying on the side opposite the kidney to be removed.

Small incisions are made in the abdomen through which the laparoscope and other surgical instruments are inserted. Carbon dioxide gas is infused to inflate the abdomen, creating a working space and improving visibility.

The urologist uses the camera on the laparoscope to visually inspect the abdominal cavity and locate the kidney.

The kidney is carefully dissected away from surrounding tissues. Blood vessels and ureters are identified, isolated, and secured.

The renal artery and vein are ligated (tied off) and cut to disconnect the blood supply to the kidney.

Once the kidney is completely free, it is placed in a small bag and removed through one of the incisions, which may be slightly enlarged if necessary.

The incisions are closed with sutures or staples, and dressings are applied.

Postoperative Care and Recovery

Effective postoperative care is essential for a smooth recovery after laparoscopic nephrectomy. Here are the main aspects of care and the typical recovery process:

Pain Management

Patients will receive pain relief medications to manage discomfort associated with the surgery. These may include oral medications and, less frequently, intravenous pain relief.

Monitoring

Close monitoring in the immediate postoperative period is important to detect any signs of complications, such as bleeding, infection, or anaesthesia-related issues.

Activity Resumption

Patients are encouraged to walk as soon as possible, usually within a day of surgery, to promote blood circulation and prevent blood clots.

Wound Care

Instructions are provided for caring for the incision sites, including keeping them clean and dry.

Diet

Initially, the diet may be limited to liquids, gradually progressing to more solid foods as the patient’s bowel function returns to normal.

Follow-Up Appointments

Follow-up visits with the urologist are scheduled to monitor the healing process, evaluate kidney function, and address any patient concerns.

Dr Png Keng Siang

Dr Png Keng Siang

Senior Consultant Urologist & Robotic Surgeon

Dr Png is a United States fellowship-trained urologist who received his urology specialist board certification from Singapore. He is the first and only urologist in Singapore to be inducted into the Fellow, American College of Surgeons (FACS) after completing a minimally invasive surgery fellowship in the USA at the Indiana University School of Medicine, where he sub-specialised in robotic and laparoscopic surgery for urological cancers.

  • Joint Committee of Specialist Training Site Accreditor, Urology Residency Program
  • President of the Robotic Surgery Society of Singapore
Prior To Private Practice:
  • Director of the Robotic Urological Surgery Fellowship Program, Tan Tock Seng Hospital
  • Director of the National Healthcare Group Urology Residency Program & Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine
  • Member of the American Urological Association, Endourological Society (USA)
  • Executive Committee of the Singapore Urological Association, 2013 to 2020
Read Full Bio

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    Laparoscopic Nephrectomy

    Frequently Asked
    Questions

    What Is the Success Rate of Laparoscopic Nephrectomy?

    Laparoscopic nephrectomy has a high success rate, particularly for patients whose conditions are diagnosed early and who do not have complicating factors. Surgical outcomes vary based on the urologist’s experience and the patient’s overall health.

    How Long Will I Be in the Hospital?

    The length of hospital stay can vary, but many patients are discharged within 1 to 3 days if there are no complications.

    How Long Does Recovery Take?

    Most patients can resume normal activities within 2 to 3 weeks after laparoscopic nephrectomy. Full recovery, including the ability to engage in strenuous activities, generally occurs within 4 to 6 weeks, depending on the patient’s overall health and adherence to postoperative care guidelines.