A Robotic Nephrectomy (RN) involves removing an entire kidney through keyhole incisions in the flank. A nephrectomyis usually done because of a nonfunctioning kidney.

In the case of kidney cancer a Robotic Radical Nephrectomy (RRN) is done. This is done to rid the body of cancer by removing the entire kidney and adrenal gland, with its surrounding fat and attached vessels. In cases of bleeding in urine it is done to stop continued bleeding from the effected kidney.

For non-functioning kidneys due to large stone a simple Robotic Nephrectomy (RN) is done. Here only the kidney is taken and other structures are spared. It is usually done to avoid recurrent infection and pain.

A wound drain is then inserted to drain any wound ooze at the culmination of surgery. This is usually stitched in place and stays in for 1 – 2 days. When the operation is finished, the carbon dioxide is removed from the abdomen and the cuts are stitched closed with dissolving stitches. The areas are then covered with small adhesive dressings. A catheter (drainage tube which drains urine from the bladder) is also inserted to monitor the urine output from the remaining kidney. The catheter usually stays in for 1 – 2 days, or until you are up and about. Robotic Nephrectomy takes approximately 1 – 2 hours to perform and involves hospital stay of around 3-4 days.

RISKS INVOLVED

With all surgery there is a risk of infection and blood loss. Antibiotics are often given during the operation to prevent infection.

In any robotic surgery, there is a risk that the surgeon may need to proceed to laparoscopic or open surgery, requiring a single, larger incision in the flank. This happens rarely and can be due to equipment failure, excessive bleeding or other difficulties encountered during the surgery.

CONSENT

Before you sign the consent form it is important that you understand the risks and effects of the operation and anesthesia. Our Anesthetists will discuss the anesthesia aspects with you.

 

Preoperative Workup

Your first preoperative consultation

Your initial consultation with us would require a review of your medical history & any other investigations if available. A brief physical examination may also be performed. Any other investigations like a CT scan, MRI or Doppler etc. as per each patient′s requirement would be done. If you are a candidate for surgery, you will then meet with our Urology Patient Coordinator to arrange for the date of your surgery.

NOTE: It is very important that you gather and bring your entire CT scan/ X-ray films and reports to your initial consultation with Dr Manav Suryavanshi.

 

What to expect prior to the surgery

Patients are required to undergo

• Investigations
  • Urology Preoperative Panel (CBC, Blood Urea, Creatinine, Sodium, Potassium, Calcium, Phosphorus, Albumin, Alkaline, Phosphatase, Uric Acid (Serum), Bicarbonate, Urine Analysis, Urine Culture, PT / INR, APTT, HbsAg, HCV Antibody, HIV I & II)
  • Chest X-ray & ECG
  • Imaging investigations as asked, after consultation.
  • PAC clearance
• Financial Clearance
  • TPA (Mediclaim)
  • Cash
• Stoppage of Blood thinners, if any after clearance by the prescribing physician.
• Filling up of Admission Form
• Confirmation of date of admission and date of surgery
• Final clarification of doubts, if any

 

Preparation for surgery

Medications to Avoid Prior to Surgery

• Any blood thinners like aspirin, clopidogrel, coumarin, acetrom, warfarin , ibuprofen, vitamin E 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′s approval.

 

Dietary advice

You will NOT be allowed to eat or drink anything for at least six hours before your surgery. Even water is not allowed six hours prior to surgery for anesthesia safety requirements.

We don′t do routine bowel preparation for our RRN patients unless specifically indicated. Patients may be routinely given Tablet Dulcolax on the night prior for which they are instructed in the ward.

 

Surgery

On admission you will be informed of an approximate operation time and prepared for theatre. You will be instructed about special deep breathing and leg exercises that you should do after surgery. If a shave of the surgical site is required, this is done just prior to shifting into the theatre. You may be given some tablets before theatre by the anesthetist for tension, nausea and pain prevention.

You will be escorted to the theatre, where you will be transferred to the theatre table. Our Anesthetist colleagues will then insert a drip in your arm and will attach various monitoring devices. Once you have been completely prepared and given your anaesthesia, surgery will begin.

RRN is performed under a G.A. The typical length of the surgery is 1-2 hours. It′s a keyhole surgery performed via 4-5 small 5-12 mm incisions. Patient is placed in the kidney position. Standard ports are established & the robot docked. The kidney is mobilized extragerotally. The renal hilum is dissected. Renal artery & vein are identified & cut between clips. If indicated, adrenal gland is dissected enbloc with the kidney, superior pole dissected & kidney freed in its entirety. The tumor is placed in a plastic bag & retrieved by extending one of the port sites or making a separate small infraumblical midline/pfannensteil incision.

 

Tubes to be expected inside the body at the end of the procedure

A drain & a Foley′s catheter are kept after the procedure is completed.

 

Post Operative Management

Your blood pressure and pulse will be checked regularly. Your wound and the drainage from it will also be monitored closely. You will have a drip in your arm to make sure you receive adequate fluids. This will be removed once you are drinking normally. You can usually drink 6 hours after surgery and you may eat once you are tolerating fluids, which is usually 24 to 36 hours after surgery. Your urine will drain from your bladder, through the catheter into a bag. The urine is likely to be blood stained; this usually clears within the first 24 hours and is not a cause for worry. The catheter is held inside your bladder by a small, inflated balloon, which prevents it from slipping out. Routinely, this is a very well tolerated procedure with minimal pain. Please tell the nurse if you have any pain or discomfort so you can be given the appropriate care. At all times, your nurse is there to help you, please ring your bell if you need assistance and your nurse is not nearby.

You will be able to be up and about as able but may need assistance the first time you get up out of bed. You should do regular deep breathing and leg exercises after surgery until you are fully mobile. The physiotherapist may come and see you to give further instructions.

POD 1 (First Day after Surgery)

You will be able to eat and drink, as you feel able. You will be able to walk to the shower and be up and about. You will be given regular pain relievers, to help keep you comfortable. If the drainage from your wound drain is minimal or less than 50 ml it will be removed. Your catheter is usually removed when you are mobile i.e. usually on the first day after surgery.

The patients are discharged on the 3 or 4th day after surgery once they are eating normally and have passed stools.

 

Discharge Instructions

You will be given a discharge letter that contains all the information regarding the procedure that has been done and the treatment that you need to follow. We also take care to appoint the patient for its first follow up visit at this time.

Once Home

You should take regular pain relief as instructed to keep you comfortable. Your wounds should heal within a few days. However, beneath your skin the muscle layers will take longer to heal. For this reason it is important to avoid any heavy lifting and straining for 2 – 3 weeks. You can take a bath at home 3 days after surgery. You may need to place a dry dressing over your wounds to collect any slight ooze so it does not stain your clothing or get dirty.

 

Follow-up

First follow up visit is done at 3-5 days after discharge to inspect the wound site. Dressings if required are changed or removed at this time. Histopathology report is usually available 5-7 days after surgery. You are supposed to sit and discussed the report with us in your follow up visit. Please preserve your histopathology report with yourself for future reference, as this constitutes important information for future reference.

The important thing to remember is that humans can survive on one kidney and there is no reason why you should not be able to function as you did prior to your surgery. A positive attitude on your part will make everything easier.

You will be given an outpatient appointment at Urofort (+91-9910103545) or at our hospital with Dr Manav Suryavanshi by Urology Coordinator (+91-9560398967) as per your convenience 5-7 days after surgery. Based on the report the follow up & the need & frequency of follow up & any adjuvant treatment; if required is decided.

Contact your doctor if

• Any of your wounds become red, hot, swollen, painful or continue to discharge
• If your urine becomes cloudy, offensive smelling or you have any other signs of a urine infection
• If you have any concerns at all
• If you have fever >100°F or rigors and chills.