People with kidney troubles already
have plenty of problems. It adds insult to injury that surgery
to remove part or all of a kidney can put someone to bed for several
weeks.
But contrast that to the recent experience
of an 81-year-old man who had a cancerous kidney removed. A week
later, he felt well enough to walk around his yard.
The secret of this quick recovery is the use
of laparoscopic surgery: instruments that enter the body in narrow
tubes, instead of the surgeon's own hands. That means far less
intrusion into the patient's body.
The use of laparoscopic surgery can dramatically
reduce the recovery time for our patients. It normally takes several
weeks to recover from a kidney operation or "nephrectomy,"
if you want to sound like a surgeon. Laparoscopic nephrectomy
relies on a small fiber-optic tube, along with other narrow instruments,
that enter the body through half-inch incisions and can be maneuvered
to reach the kidney. Carbon dioxide is pumped into the body to
give the surgeon room to work.
The surgeon can then remove the kidney in a
couple of different ways. If the kidney needs to come out whole
for testing, the surgeon can pull it through an incision of 3
to 4 inches, or less. If the kidney does not need to come out
whole, the surgeon can dissect the organ and remove it through
the original half-inch incision.
Laparoscopic surgery has been around for a
number of years. It has only been in the last few years that doctors
in some parts of the country have used it to remove kidneys. Laparoscopic
surgery is not appropriate in all cases, Porter says. But when
it can be used, patients report they're pleased with how quickly
they are up and about.
In a conventional nephrectomy, the surgeon
must make a 12- to 18-inch cut nearly from the belly button to
the spine, slicing through three muscle groups to get to the kidney.
Sometimes, the surgeon must remove a rib to get enough space.
The laparoscopic technique involves a quarter
of the blood loss, or less, compared to a conventional surgery.
It also means a hospital stay of 2 1/2 to three days, instead
of six. And the patient can often return to work in three weeks
instead of seven.
Dr. Schoenfeld uses the laparoscopic device
for many other surgeries. One surgery is called laparoscopic nephropexy:
the surgeon fixes kidneys that otherwise "drop" when
the person stands, causing considerable pain.
The laparoscope can take a biopsy of a kidney
tissue to check for disease. Another laparoscopic procedure removes
the kidney and ureter the tube that drains urine into the bladder
to battle one form of cancer. In young men with testicular cancer,
the surgeon may use the device to remove lymphatic tissue and
determine the extent of the disease. As with other procedures,
the alternative to the laparoscopic procedure is more painful.
