Laparoscopic nephrectomy

The most common reason for a laparoscopic nephrectomy is kidney cancer. The surgery may also be performed if your kidney is damaged or not working properly due to injury or disease.

A nephrectomy may also be performed to remove a healthy kidney from a donor during a kidney transplant.

There are two main types of laparoscopic nephrectomy. The type of surgery you will have will depend on your diagnosis and, in cases of kidney cancer, how far the cancer has spread. A nephrectomy can be unilateral (removal of one kidney) or bilateral (removal of both kidneys).

Radical (complete) nephrectomy

This is the removal of the entire kidney and possibly some of the surrounding tissues and structures such as the ureter (the tube between the kidney and the bladder), adrenal gland, and lymph nodes.

Partial nephrectomy

In this type of surgery, only the diseased part of the kidney is removed, and healthy tissue remains in place. This is also known as a nephron-sparing or kidney-sparing nephrectomy.

There are many benefits of laparoscopic nephrectomy over open surgery including:

• Less blood loss during the operation
• Less post-operative pain
• Lower risk of complications after surgery
• Shorter hospital stay
• Faster recovery time

Mr Ian Dunn, consultant urological surgeon at Ross Hall Hospital, says:

"The potential benefits of laparoscopic surgery compared to traditional open surgical procedures are: less blood loss, less pain, shorter recovery times and a better cosmetic outcome. It is generally a safe procedure with a low complication rate. Like most major abdominal procedures, however, complications can occur, though these are generally of a minor nature and will be explained by your surgeon."

At your first consultation, you will usually be seen by a consultant urologist, a doctor specialising in conditions affecting the bladder and urinary system.

Your consultant will ask you about your symptoms and general health and perform a physical examination. If you have had any previous tests or scans, please bring them with you to your appointment. Your consultant may look at your previous tests or scans or arrange for them on the day. These may include a blood test, ultrasound, CT, or MRI.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

At the end of your appointment, your consultant will decide whether laparoscopic nephrectomy is suitable for you based on your symptoms, diagnosis, general health, and medical history. They will explain the surgery to you including what happens during the procedure, any possible risks, and complications, and what to expect during your recovery.

It is important to us that you are as well-informed and comfortable as possible before, during, and after your surgery, so please discuss any questions or concerns you have during your appointment.

Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have, and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

Before your operation, you will have some tests including a blood test, ECG, and chest X-ray to make sure you are fit for surgery.

Do not eat or drink anything including water from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Laparoscopic nephrectomy is carried out under general anaesthetic which means you'll be asleep for the procedure.

Once the anaesthetic has taken effect, your consultant will make one or more incisions (cuts) into your side or abdomen. Carbon dioxide gas is pumped into the abdominal cavity to allow your consultant to see your organs more clearly.

Your consultant will insert a small, flexible camera called a laparoscope through one of the incisions. Using images from the camera to see what's going on inside your body, your consultant will use surgical instruments to remove all or part of the diseased kidney.

The incision is closed using dissolvable stitches and a sterile dressing is applied. Laparoscopic nephrectomy normally takes between three and four hours.

Recovery from any type of surgery varies from person to person and depends on many factors including your age, general health and whether or not there were any complications during your surgery.

Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

What will happen after the surgery?

After your surgery, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.

When you come around from the anaesthetic, you will have a urinary catheter (a tube in your bladder that drains urine). This is so that medical staff can see how much urine your remaining kidney is making.

You will be encouraged to get up and move around as soon as you are able after surgery. This is to reduce the risk of blood clots forming in your legs after your operation.

It's normal to have some post-operative pain for the first few days after your surgery. Your consultant will prescribe pain medication to manage this, but please let a member of your healthcare team know if you experience any pain or discomfort after your surgery.

You will have several small wounds where the incisions were made during your operation. They are normally closed with dissolvable stitches that don't need to be removed. You can expect mild discomfort and bruising around your wounds for several days after surgery. Follow your consultant's instructions about how to care for your wounds and call the hospital immediately if you have:

• Worsening pain, redness or swelling around the wound
• An increase in discharge from the incision site
• Strong smelling discharge
• Fever (a temperature of 38C or above)

How many nights will I need to stay in hospital?

How long you need to stay in hospital varies from a few nights to around a week depending on your age, general health, and the type of procedure you had. Talk to your consultant about how long you can expect to stay in hospital after your surgery.

Will I be able to drive home?

You will not be able to drive yourself home from the hospital after your surgery. Please make arrangements for someone to collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on what was done during your procedure, your individual recovery, and the type of job you do. If your job is sedentary, such as office work, you may be able to go back to work after around three weeks. If your job is strenuous or involves heavy lifting, you may need six to eight weeks off work after your surgery. Your consultant can give you an idea of when you can expect to return to work after your surgery.

How soon can I drive?

You should not drive until you can sit comfortably for extended periods, safely control your vehicle, and perform an emergency stop without pain. This is normally around two weeks after your surgery. Check with your consultant and inform your insurance company before driving after your laparoscopic nephrectomy.

When will I be back to normal?

Recovery from laparoscopic nephrectomy is a gradual process that is different for everyone. It's important that you go at your own pace during your recovery, increase your activity level gradually and stop if you feel tired or have pain. Follow your consultant's instructions carefully during your recovery and call the hospital if you have any questions or concerns.

Your consultant will arrange for you to have a blood test to check the function of your remaining kidney around six weeks after your surgery. You will need to have your kidney function checked regularly for the rest of your life after your nephrectomy.

As with all types of surgery laparoscopic nephrectomy carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure.

Make sure you are fully informed about the possible risks and complications of your procedure so that you can make an informed decision.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to laparoscopic nephrectomy include:

• Temporary abdominal swelling, neck, and shoulder pain due to the carbon dioxide gas pumped into the abdomen during the procedure
• Injury to the surrounding organs or blood vessels that may lead to open surgery
• Bleeding that requires a blood transfusion or leads to open surgery

Laparoscopic nephrectomy may not be suitable for everyone. Your consultant will discuss the best treatment options with you depending on your age, general health, and diagnosis.

Some alternatives to laparoscopic nephrectomy include:

• Open nephrectomy - traditional open surgery to remove all or part of a kidney
• Radiofrequency ablation or cryotherapy - where cancer cells are destroyed by heating or freezing them
• Embolisation - where the blood supply to the tumour is cut off
• Radiotherapy - controlled radiation is used to target cancer cells
• Medications - these can help stop the cancer from growing and spreading

We answer some of your most commonly asked questions about laparoscopic nephrectomy.

Can kidney cancer come back after laparoscopic nephrectomy?

Kidney cancer can sometimes come back after surgery. The chances of your cancer returning decrease the longer you are cancer-free. You will have regular follow-ups to check for cancer for many years after your nephrectomy. Talk to your consultant about what kind of follow-up care you can expect after your surgery.

Is a nephrectomy major surgery?

Yes. A nephrectomy is major surgery and requires a general anaesthetic, a hospital stay and a significant recovery time. Laparoscopic nephrectomy is a minimally-invasive technique with a shorter recovery time than traditional nephrectomy but is still considered major surgery.

Can I drink alcohol after laparoscopic nephrectomy?

You should avoid alcohol for at least the first twenty-four hours after your surgery and while you are taking other medications such as painkillers or antibiotics. After this, you may be able to drink in moderation, but this will depend on other factors such as your general health and the type of surgery you had. Talk to your consultant about whether it's safe to drink alcohol after your surgery.

Does the remaining kidney grow after a nephrectomy?

When one kidney is removed, the remaining kidney may increase in size and function. This is known as compensatory growth. In one study, almost half of patients who underwent a radical nephrectomy for kidney tumours had restored kidney function to pre-operative levels within two years.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about laparoscopic nephrectomy, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in March 2023. Next review due March 2026.

1. Laparoscopic nephrectomy (including nephroureterectomy), NICE
2. Laparoscopic Nephrectomy, York and Scarborough Teaching Hospitals NHS Foundation Trust
3. Long-Term Renal Function Recovery following Radical Nephrectomy for Kidney Cancer: Results from a Multicenter Confirmatory Study, The Journal of Urology