Heminephrectomy Laparoscopic

Heminephrectomy laparoscopic surgery

Laparoscopic heminephrectomy is a minimally invasive operation where for the entire kidney is not removed just the diseased or non-functioning part (upper or lower pole) is cut out leaving the rest of the healthy part intact. The only stating indication for this intervention is in a patient with duplex (two kidneys) system wherein one kidney is not functioning normally or causing problems.

What is a Laparoscopic Heminephrectomy?

• Keyhole surgery is performed through small cuts.
• The laparoscope (camera) and specialized instruments are introduced.
• It removes one of the kidney (upper or lower pole) and ureter, if required.
• Denotes preservation of renal function by sparing normal kidney tissue. 

Indications (Why It Is Done)

Laparoscopic heminephrectomy is suggested in case of:

• Duplex kidney without upper or lower moiety functionality.
• Repetitive UTIs
• Ureterocele
• Severe hydronephrosis
• One renal segment vesicoureteral reflux.
• Renal dysfunction segment producing pain or infection.

The benefits of Laparoscopic Heminephrectomy

• Smaller incisions
• Less postoperative pain
• Minimal blood loss
• Faster recovery
• Shorter hospital stay
• Better cosmetic outcome
• Kidney function preservation.

Laparoscopic heminephrectomy procedure

Laparoscopic heminephrectomy is a minimally invasive surgical procedure in which either the upper or lower part (moiety) of a kidney is removed when it is non-functioning, but the rest of the kidney is left intact. 

Preparation Before surgery

Prior to surgery the following are done: 

• Blood tests & urine analysis
• Ultrasound / CT urogram / MR urogram.
• Renal scan (DTPA or MAG3) to rule out non-functioning moiety.
• Antibiotics begun in case of infection.
• Fasting for 6–8 hours
• Fitness clearance in general anaesthesia.

Anaesthesia & Positioning

• Surgical and done under general anaesthesia.
• Patient is in the lateral (side-lying) position.
• Fortification to avoid nerve damage.

Keyhole (Port) incisions

• 3–4 small incisions (5–12 mm)
• Laparoscope (camera) has one port.
• Surgical instruments had ports left.
• Carbon dioxide gas put in the abdomen to enhance visibility.

Exposure of the Kidney

• To reach the kidney, colon is moved about to reach it.

Kidney identified and:

• Renal artery & vein
• Affected renal segment (lower or upper pole)
• Corresponding ureter

Diseased Moiety Identification

• Vessels serving non-functional segment are isolated with great care.
• Segmental vessels only are clipped in order to safeguard the healthy kidney.
• Tracing is required in case it should be removed.

Segmentation and Excision of the Kidney

Diseased kidney segment is separated using:

• Energy devices
• Staplers or clips

Care taken to:

• Maintain the collection system of healthy moiety.
• Prevent urine leakage
• Sampler in a retrieval bag.

Hemostasis & Closure

• Checked and controlled bleeding points.
• Surgical field irrigated
• Drain can be put on temporarily.
• Kidney bed inspected
• Minor cuts, sutured or stapled.

Completion of Surgery

• Specimen cut using a single port.
• Carbon dioxide released
• Skin sealed up with absorbent sutures.
• Duration: 2-4 hours.

Post-Procedure Care

• Medication control of pain.
• The concept of early mobilization was promoted.
• Oral diet initiated within 24hours
• Drain removal in 1–3 days
• Discharge in 2–4 days

Laparoscopic heminephrectomy recovery

The laparoscopy procedure of heminophrectomy recovery is normally easy and quick compared to the open surgery since minimal incisions are made and healthy kidney tissue is not totally excised. The following is a step by step recovery guide both to the patients and caregivers.

Immediate Post-Surgery (Day 0–1)

• Monitored in recovery room
• Light to moderate pain, managed by IV/oral drugs.
• Catheter on urine normally pulled off within 24 hours.
• IV fluids, then liquid diet.
• Highly encouraged to sit up and walk in 12-24 hours.

Hospital Stay (Day 2–4)

• Slow reintroduction of normal food.
• Drain (when installed) removed in 1-3 days.
• Walking independently
• Pain significantly reduced

Discharge once:

• Afebrile
• Good urine output
• Controlled pain using oral medication.
• Average hospital stay: 2–4 days

First 2 Weeks After Discharge

• Mild abdominal cramping or aching.
• Fatigue is common
• Little wound dressings were clean and dry.
• Do not move any heavy objects (>5 kg).
• Light daily activities and walking suggested.
• Good water intake which is vital to the health of the kidneys.

Weeks 3–6

• Majority of the patients revert to offices or light work.
• Pain nearly resolved
• Slow growth of activity.
• It is recommended to avoid hard exercise, running or gym workouts.
• Incisions fully healed

After 6 Weeks

• Get back to routine physical exercise.
• Physical activity permitted by the doctor.
• Complete recovery in the majority of the cases.

Postoperative Follow-Up 

• Initial follow-up: 7 -10 days (wound check)
• Renal scan / ultrasound: 4–6 weeks
• Routine kidney function examination.
• Prolonged observation particularly in children.

Pain & Wound Care

• Slight and intermittent pain.

Keep wounds:

• Clean
• Dry
• Observes redness or discharge.
• The sutures are also absorbable most of the time.

Diet During Recovery

• Normal diet unless otherwise.
• High-fluid intake
• Low-salt diet recommended
• The use of alcohol should be avoided in the course of 4 weeks.

Laparoscopic heminephrectomy complications

Laparoscopic heminephrectomy is a secure and proven kidney-saving operation, yet any surgical intervention is associated with certain risks. Most complications are infrequent and are greatly minimized when the procedure is performed by a skilled urologist. 

Complications During Surgery

• Bleeding
• Injury to Surrounding Organs
• Difficulty in Identifying Renal Anatomy
• Conversion to Open Surgery

Early Complications (First Days to Weeks)

• Urine Leak
• Infection
• Pain or Ileus
• Hematoma or Seroma

Late Complications (Weeks to Months Later)

• Loss of Function of Remaining Moiety
• Recurrent UTIs
• Hypertension
• Incisional Hernia

Robotic laparoscopic heminephrectomy

Robotic laparoscopic heminephrectomy is a novel but minimally invasive procedure where the non-functioning upper or lower portion (moiety) of a kidney is removed by the robot-assisted system (e.g. the da Vinci platform), without damaging the healthy renal parenchyma. It is a method of laparoscopy with a high degree of accuracy and manipulation.

What Makes It “Robotic”?

• Surgeon operates robotic arms remotely.
• Offers 3D high-definition, magnified eye sight.
• Wristed instruments permit 7 degree movement (better than human wrist).
• Eliminates hand tremor

Indications

Robotic heminephrectomy is desirable in:

• Non-functional moiety duplex kidney.
• Complicated renal vascularity.
• Recurrent UTIs
• Ureterocele
• Severe hydronephrosis
• Young and adult patients with a high level of precision.

Benefits of Robotic Heminephrectomy

• Likewise high detail in intricate anatomy.
• Lower risk of urine leak
• Improved kidney conservation.
• Minimal blood loss
• Less post-operative pain
• Faster recovery
• Good results among children.

Best hospital laparoscopic heminephrectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Laparoscopic and robotic heminephrectomy is safe, effective and kidney-preserving surgery in patients with a non-functioning upper or lower segment of the kidney, which is the most common in duplex renal systems. With reduced morbidity through replacement of the diseased only and sparing of healthy renal tissue, these minimally invasive techniques can be used to sustain long-term renal results and quality of life. Robotic heminephrectomy offers greater benefits of added precision and 3D visualization but at a higher cost in complicated anatomy. Choosing the right patient and performing extensive pre-operative imaging and having highly skilled surgical skills ensures that the complication rates are low and the success rates are more than 95. The majority of patients (adults, as well as children) resume their regular activities within several weeks and do not need more than a regular follow-up.

Laparoscopic heminephrectomy India GetWellGo

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FAQ

Is heminephrectomy a big operation?

• It is a major urological operation, when performed laparoscopically or robotically it is less traumatic than open surgery with a faster recovery.

Is there a chance that kidney function will be impaired after surgery?

• No. Because the diseased section is not working, taking it out doesn't bring down overall kidney function. The remnant is usually well compensated.

Should I expect to go on dialysis after heminephrectomy?

• No. Dialysis is not needed because the viable kidney tissue is retained.

Is this surgery safe for children?

• Yes. Heminephrectomy in a child is a routine procedure especially for duplex kidneys, with very good long term results.

What is the success rate of laparoscopic heminephrectomy?

• The success rate is over 95% with low complication rates and excellent kidney preservation.