Laparoscopic radical nephrectomy for kidney cancer is performed by a Urologist (kidney surgeon) in an operating room. Prior to scheduling the procedure, each patient should have an extensive consultation with their Urologist regarding the nature of their kidney disease as well as all of the available treatment options. This discussion should review all the advantages and limitations of each surgical and non-surgical approach.
Once you and your Urologist have decided on laparoscopic radical nephrectomy, a date for surgery is chosen. Typically, a patient goes to the hospital on the day of surgery. General anesthesia (you are completely asleep) is required. The Procedure is then done through three or four small incisions which are either 1/2 a centimeter or 1cm in length (less than 1/4 to 1/2 and inch). The kidney is then identified but never actually seen as it is surrounded by both fat and the leathery layer known as Gerota’s fascia. The surgeon identifies and controls the renal artery (blood supply to the kidney). Once the artery is controlled, attention is turned to the vein which is also controlled. The entire specimen is then separated from all of its attachments to the body and put into a sack while still inside of the body.
There are two means for removal of the kidney. Intact extraction means that an incision is made and the entire kidney (while still inside the sack) is removed. Usually, the incision is just smaller than the size of the kidney and the kidney cancer as the body’s tissues are flexible and will stretch slightly to allow removal of the specimen. Another technique for removal of the specimen is known as morcellation. Morcellation involves the fragmentation of the kidney including the kidney cancer within the body so that it can be removed through a smaller incision. The goal of morcellation is to maximize the minimally invasive nature of the kidney surgery by removing the kidney and kidney cancer through the smallest cut possible. A smaller cut is usually associated with less pain and a more rapid recovery. An additional benefit of the smaller cut for removal of the kidney and kidney cancer is that there is usually a better cosmetic result.
The process of “morcellation” must be done with great care using well-defined techniques as the breaking up of the kidney and the cancer is associated with risks when not performed very meticulously. These risks should be discussed with your surgeon prior to the procedure.