A radical nephrectomy procedure is performed on patients with kidney cancer with the aim of removing the entire kidney and its surrounding tissues with or without the closely lying adrenal gland. It is usually deemed necessary when surgically treating larger kidney cancer tumours or cancerous tumours where the size, position and anatomy suggests that a partial nephrectomy or some other nephron sparing approach is inappropriate.
A radical nephrectomy remains the mainstay of surgical management of kidney cancer. Whilst traditionally this was performed through large wounds in the upper abdomen, in the modern era most are performed with key-hole or laparoscopic techniques, be they robotically assisted or not.
Whichever approach is employed, the kidney surgery may then be performed either trans-peritoneal, (through the abdominal cavity), necessitating the mobilization of bowel to gain access to the kidney or via the extra-peritoneal route i.e. avoiding the bowel.
Approach is usually down to the kidney surgeon’s preference or experience although other factors may come into play e.g. history of previous abdominal surgery; appendicitis, bowel surgery, gall bladder surgery etc. Whilst our preference is the extra-peritoneal route, we perform a radical nephrectomy via which ever approach seems most appropriate for an individual patient.
Robotic assisted laparoscopic radical nephrectomy
A laparoscopic or robotic assisted laparoscopic radical nephrectomy is performed using 3 or 4 small holes, one of which will be extended to allow removal of the kidney and surrounding tissues in the bag in which it is placed at the end of the procedure.
The main risks of the procedure relate to that of heavy bleeding and the need to convert to ‘open’ surgery. Our current risk is less than 1% and to adjacent organ damage e.g. bowel, our current risk is less than 0.5%.
The operation usually takes about 1 ½ to 2 hours. Most people are mobilising the following day, having had their post-operative urinary catheter (draining tube) removed that night, and are home, on average, after 2 nights in hospital.