Product Summary: Open Radical Nephrectomy with Nodes for large tumours
Item Number: 36529, 105
For large renal tumours where laparaoscopic procedure may be contra-indicated. Bigger invasive procedure and may incur longer hospital stay and prolonged recovery process
Why is it done?
Incidental finding of a solid renal mass larger than 8-10cm suspicious of a renal cancer.
A symptomatic non-functioning kidney with the history of inflammation and abscesses where a large inflammatory process was involved making surgery technically more difficult.
Late symptoms include:
- Palpable Mass.
- Flank pain.
Possible crative process for Renal Cell Carcinoma.
Cyto-reductive process prior to or post Tyrokinase Inhibitor (TKI) treatment.
- CT abdomen and chest.
- MRI if in Renal Failure or Contrast.
Chemo-Oncologist will also be involved in your care (not for the non-functioning kidney).
Risk for post-operative dialysis will have been discussed prior to your surgery by means a referral; to a Nephrologist.
How is it done?
- Patients will receive a general anaesthesia, unless contra-indicated.
- Prophylactic anti-biotics is given.
- An indwelling catheter is placed.
- The correct kidney is identified and marked while you are awake.
- A large sub-costal incision is made 2cm under your ribcage stretching from your side to just across the midline of the other side of your abdomen.
- The muscles are cut.
- The colon is reflected to reveal the retro-peritoneal space.
- The ureter is identified and cleared up to the hilum.
- The arteries are identified and tied off and cut first. More than 1 can be present.
- Then the vein/ viens are tied and cut.
- The rest of the kidney is mobilized with its surrounding fat and removed.
- The adrenal gland is also removed in large tumours and upper pole tumours.
- Lymphnodes surrounding the blood supply to the kidney will be removed if the tumour is larger than 4 cm.
- You will spend up to 5-7 nights in hospital.
- You will have a catheter for that time.
- A drain for 2-3 days.
- You will a trial without the catheter on the 3rd day.
- Renal functions will be checked daily.
- You may enter a phase of poly-uria. High production of urine as the remaining kidney adjusts to the higher work-load.
- You will be discharged as soon as your renal function has stabilised and you can function independently
- Allow for 6 weeks for stabilization of symptoms.
- Restrict fluid intake to less than 3 L per day.
- A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
- A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporisation.
- Don’t hesitate to ask Jo if you have any queries.
- DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!
- Minimal to significant blood loss, which may require a blood transfusion.
- Wound Infection.
- Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
- Prolonged hospital stay due to impaired renal function recovery.
- Dialysis as discussed by your Nephrologist, if pre-operatively indicated.
- Post-operative Immunotherapy as prescribed by your Oncologist.
- NB! Each person is unique and for this reason symptoms vary!
The correct side for surgery should be checked:
- CT scan present
- Your approval
- Prior to anaesthesia being commennced.
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