Nephrectomy (removal of entire kidney and its surrounding fat) can be performed as an open, laparoscopic or da Vinci robotic procedure. There are various indications for this procedure including a malignant tumour such as a renal cell carcinoma, a non-functioning kidney from chronic obstruction or infection, a congenitally small kidney or in live-related donor kidney transplantation. Partial nephrectomy for renal cell carcinoma is becoming increasingly popular in selected cases of small renal cell carcinoma. This procedure involves removal of the small renal tumour with preservation of the rest of the ipsilateral kidney. This procedure can be undertaken as an open or laparoscopic procedure in carefully selected cases. Laparoscopic nephroureterectomy is the removal of the kidney including the ureter. This is usually done for transitional cell carcinoma (instead of renal cell carcinoma) of the kidney or ureter. In most cases, patient can lead a normal healthy life with one normal kidney and ureter remaining.
Open, laparoscopic or da Vinci nephrectomy is performed with the patient under a general anaesthesia. In open nephrectomy, a large incision is made either in the flank/side or the front of the abdomen. The ureter and kidney blood vessels are disconnected and the kidney is then removed. In laparoscopic nephrectomy, four of five small cuts are made in the abdominal area instead of a large incision. One of the incisions is then enlarged slightly for removal of the kidney and its surrounding fat, usually in a sterile plastic bag. Recently, laparoscopic nephrectomy has been performed using a single incision in the patient’s abdomen. This technique is called the single-port access surgery. This is done using a special access port which can accommodate 3 laparoscopic instruments.
The benefits of a laparoscopic da Vinci radical or laparoscopic partial nephrectomy are smaller incisions leading to less pain and narcotic analgesic requirements, quicker recovery, earlier discharge from the hospital and earlier return to normal duties, less post operative ileus, less blood loss, improved cosmesis with less scarring and less wound hernia/bulge. Worldwide studies have shown that laparoscopic radical nephrectomy can produce oncological outcomes equivalent to an open nephrectomy and it is now considered the “gold standard” operation for simple benign or malignant renal tumours.