Overview of Laparoscopic Nephrectomy

A doctor may recommend a laparoscopic nephrectomy for people with kidney cancer or a non-functioning kidney.

Nephrectomy for cancer

A nephrectomy is one of the most common kidney cancer treatments. Surgeons often perform laparoscopic nephrectomies to treat cancer at stages 1–3. A partial nephrectomy, where they remove only part of the kidney, can treat tumors smaller than 3 inches across.

Additionally, laparoscopic cytoreductive nephrectomy is a common choice for treating stage 4 kidney cancer. This procedure involves a surgeon removing the kidney once the cancer has spread to distant tissues to help reduce symptoms or slow the cancer’s spread.

Nephrectomy for other kidney conditions

Other conditions that may require a nephrectomy include:

• traumatic kidney injury
• kidney infection
• kidney irregularities present from birth
• noncancerous tumors

A laparoscopic nephrectomy can potentially cure kidney cancer. In the United States in 2012–2018, people with kidney cancer lived for at least 5 years 77% as often as people without kidney cancer. People with cancer contained to the kidney lived for at least 5 years 93% as often.

In a 2020 study, researchers compared the effectiveness of laparoscopic nephrectomy with open nephrectomy at two hospitals in South Africa. They found that laparoscopic surgery was superior in terms of:

• blood loss
• transfusion rate
• length of hospital stay
• overall complication rate

Laparoscopic surgery didn’t perform worse in terms of:

• operative time
• cancer outcome
• rates of serious complications

Side effects that occur in most people who get a laparoscopic nephrectomy include pain around the incision site and abdominal bloating.

Side effects that occur in 2–50% of people include:

• shoulder tip pain due to diaphragm irritation from carbon dioxide, which a surgeon pumps into the body to make the kidney appear more visible
• bleeding requiring further treatment
• infection
• hernia
• injury to organs or blood vessels requiring conversion to open surgery

Fewer than 2% of people experience:

• bleeding requiring a blood transfusion or conversion to open surgery
• lung cavity injury
• cardiovascular problems
• reactions to the anesthetic requiring blood transfusion
• infections picked up in the hospital

The risk of death is less than 1%.

Here’s what you can expect before and during your procedure.

Before the procedure

About a week before your procedure, you’ll have a pre-assessment where your doctor will assess your fitness and give you the opportunity to ask any questions you might have about your procedure.

On the day of your procedure, you’ll have another opportunity to ask questions. The doctor may offer you a sedative orally or intravenously, which means into a vein, about an hour before your surgery.

In the operating room, you’ll receive an anesthetic to put you to sleep. Usually, a doctor will administer the anesthetic through a vein in your arm.

During the procedure

Here’s what you can expect during your procedure:

1. Once you’re asleep, your surgeon will position you on an operating table so that your kidney is accessible.
2. They’ll place a catheter in your bladder to deflate it during the procedure and to measure your urine output after.
3. Next, they’ll make a small cut of about half an inch in your abdomen, next to your belly button. They’ll insert a plastic tube called a port into your abdominal cavity and pass carbon dioxide through it to inflate the cavity. They’ll then pass a narrow tube with a camera through the port to look inside your abdomen. They usually make two or three other incisions for other ports.
4. The surgeon will pass special instruments through the ports to perform the operation. They’ll use these instruments to detach your kidney.
5. They’ll then lengthen one of the cuts to about 2–3 inches to allow your kidney to pass through.
6. Finally, they’ll close your wounds with stitches and cover them with bandages.

You’ll get some tests during your pre-assessment, including:

• blood tests
• a chest X-ray
• electrocardiogram

If you smoke, a doctor may recommend that you stop a few weeks before your operation. This can reduce your chance of developing a chest infection.

You’ll need to stay at least 1 night in the hospital, but it’s common to stay up to 3 nights. You’ll likely be connected to an epidural, which is a type of anesthetic, for 2–3 days. Also, you may not be able to eat or drink normally for a couple of days.

You can slowly start resuming your daily activities as you feel ready. It can take 4–6 weeks to fully recover from this procedure.

The price of laparoscopic nephrectomy depends on factors like where you live and the clinic where you have your procedure. Medicare and most other insurance providers cover laparoscopic nephrectomy when it’s medically necessary.

The nonprofit FAIR Health estimates that the in-network cost in New York City is $7,121 and in Oklahoma City is $1,766.

An open laparoscopy is an alternative to laparoscopic nephrectomy. It’s a more invasive procedure that involves removing the entire kidney through a large incision.

Here are some frequently asked questions about laparoscopic nephrectomies.

How long does it take to recover from a laparoscopic nephrectomy?

It can take 4–6 weeks to fully recover from your procedure. A typical hospital stay is 1–3 days.

What’s the difference between nephrectomy and laparoscopic nephrectomy?

An open nephrectomy involves removing your kidney through one large incision. A laparoscopic nephrectomy involves using small incisions and smaller tools.

A laparoscopic nephrectomy can be lifesaving, but it does come with risks. Following your surgeon’s pre- and postsurgery instructions gives you the best chance of avoiding serious complications.