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Robot Assisted Radical Nephrectomy |
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Robot Assisted Radical Nephrectomy is a minimally invasive surgical technique to
remove the entire kidney and surrounding fat. This surgery is performed to treat
primary renal tumors. When compared to conventional open surgery,
Robotic surgery results in significantly less post operative pain, shorter
hospital stay and earlier return to work and daily activities. It gives a more favorable
cosmetic result while the oncological outcomes are identical to that of open surgery.
Not all the cases are candidates for a robotic approach (depending upon the tumor
size, extent of spread of tumor etc). You should discuss with your doctor to determine
whether you are the right candidate for this approach. |
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The Surgery
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Robot assisted Radical Nephrectomy is performed under general anesthesia. The typical
duration of the operation is 3-4 hours.
The surgery is performed through 3 to 5 small incisions (5-12 mm) made in the abdomen.
The robotic arms with its attached instruments (that includes a camera) are passed
through these “keyholes”. The camera provides the surgeon a 3-dimensional, high
definition, magnified view of the tissues inside the body. Various types of Endowrist
instruments with capability to move in various directions allow the surgeon to precisely
dissect the kidney along with the tumor and make it completely free without having
to place his hands into the abdomen. The dissected kidney, its surrounding fat and
sometimes the adrenal gland (if removed) are then placed in a sterile retrieval
bag and removed through a small incision. The entire kidney with the tumor is then
sent to the pathologist for complete examination and to evaluate for detailed histopathological
diagnosis.
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What are the potential risks and complications? |
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Although the safety and efficacy of this procedure has been well established for
selected patients, as with any surgical procedure, there are risks and potential
complications. The safety and complication rates are similar when compared to the
open surgery. Potential risks include:
- Bleeding: Blood
loss during this operation is typically minor (average of 100ml) and need for blood
transfusion is observed in less than 5% of the patients. If you are interested in
autologous blood transfusion (donating your own blood) you must make your surgeon
aware.
- Infection: In
order to decrease the chance of infection after surgery, all patients are treated
with intravenous antibiotics given prior to the surgery. If you develop any signs
or symptoms of infection after the surgery {fever (>100.5o F) drainage from incision,
urinary frequency/discomfort, pain or anything that you may be concerned about},
please inform your doctor immediately.
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- Tissue / Organ Injury:
Although uncommon, possible injury to the surrounding tissue and organs including
bowel, lung, vascular structures, spleen, liver, pancreas and gallbladder could
require further surgery. In case of partial nephrectomy, loss of kidney function
is a rare but potential risk. Scar tissue may also form in the kidney requiring
further surgery.
- Conversion to Open Surgery:
The surgical procedure may require conversion to the standard open operation. The
conversion to open surgery should not be considered as a failure of the procedure
but it is a sound surgical decision made by the operating surgeon to complete the
challenging procedure safely and effectively without compromising the results. This
could result in a larger than standard open incision and possibly a longer recuperation
period.
- Pathology: After
the surgery, the pathologist will review the specimen in detail. The detailed information
available from the pathological examination of the specimen helps in decision regarding
any further treatment and followup of the disease. Approximately 15% of patients
may have a final diagnosis of a benign tumor.
- Hernia: As with
any surgery, a hernia may form at the surgical site. Injury could also occur to
nerves or muscles related to positioning.
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What to expect immediately after the surgery |
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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.
- Post Operative
Pain: Pain medications are used to control the pain associated with the
incision after the surgery. Pain medication can either be controlled and delivered
by the patient or administered by the nursing staff via an intravenous catheter.
You may also experience some minor transient shoulder pain (1-2 days) related to
the gas used to inflate your abdomen during the laparoscopic surgery. Most patients
see a large improvement in their pain level on the second day after surgery.
- Nausea: You may
experience some nausea related to the anesthesia. Medication are given to treat
nausea.
- Urinary Catheter: You can expect to have a urinary catheter
draining your bladder (which is placed in the operating room prior to surgery) for
approximately one to two days after the surgery.
- Diet: You can
expect to have an intravenous catheter (IV) in for 1-3 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.). Following surgery, the bowels
will transiently “go to sleep”. Most patients are able to tolerate ice chips and
then clear liquids the day after surgery. The diet is then advanced as tolerated
by the patient. Once on a regular diet, pain medication will be taken by mouth instead
of by IV or shot.
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- Fatigue: Fatigue
is common and afternoon fatigue is common even several weeks beyond surgery. This
is part of the body’s normal healing process.
- Incentive Spirometry:
You will be expected to do some very simple breathing exercises to help prevent
respiratory infections by using an incentive spirometry device (these exercises
will be explained to you during your hospital stay). Coughing and deep breathing
is an important part of your recuperation and help prevent pneumonia and other pulmonary
complications.
- Ambulation: On
the day after 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 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 for approximately 2-3 days.
- Constipation:
You may experience sluggish bowels for several days or several weeks. This is a
combination of the surgery as well as the narcotic pain medicines. Suppositories
and stool softeners are usually given to help with this problem. Taking stool softeners
and mineral oil daily at home will also help to prevent constipation.
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What is to expect after discharge from the
hospital |
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- Pain Control:
You can expect to have some pain that may require pain medication for 2-7 days after
discharge, and then paracetamol tablet should be sufficient to control your pain.
Do not restart aspirin or blood thinner medicines until you have seen your surgeon
and he gives the okay.
- Showering: You
may shower at home. Your wound sites can get wet, but must be patted dry. Tub baths
can soak your incisions and therefore are not recommended in the first 2 weeks after
surgery. 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
walks is 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
keep yourself well hydrated. Discuss with your doctor if you need to be on a salt
or protein restricted diet.
- Pathology results:
The results from final histopathological analysis by the pathologists are usually
available in one week time following surgery. Your doctor will discuss the results
and its implication on future treatment at the time of your followup visit.
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