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'''Urine leak'''<br />
'''Urine leak'''<br />
After a partial nephrectomy, you may have a drainage tube that comes out of one of the port sites on your abdomen that drains blood tinged fluid.  It is usually removed before discharge.  If persistent drainage occurs, you may go home with the drain and have it removed in your doctor’s office.
After a partial nephrectomy, you may have a drainage tube that comes out of one of the port sites on your abdomen that drains blood tinged fluid.  It is usually removed before discharge.  If persistent drainage occurs, you may go home with the drain and have it removed in your doctor’s office.
== Recommendations ==
Bringing a few items with you may assist with your pre-operative and post-operative care.
'''Pre-Operative Recommendations'''<br />
''Clear liquids and soft diet foods'': clear liquids such as the pre-packaged Jell-O, chicken/beef broth soups, or juices (no pop or carbonated beverages).  The Soft diet foods that are allowed are oatmeal or cream of wheat packets, fruits such as bananas, peaches pears, and/or sandwich items.  It may be more convenient if you bring these items with you on your trip to Detroit if you do not have a vehicle and/or feel uncomfortable in an unknown area. 
'''Post-Operative Recommendations'''<br />
''Loose Fitting Clothes'': such as a drawstring or elastic waist pants.
''Polysporin Ointment or Neosporin and Pain Ointment and/or Astroglide'': to apply to port sites after bandages have been removed or fallen off.
''Stool Softener'': Senokot-S or Pericolace have been good choices for patients in the past. 
''Milk of Magnesia (MoM)'': for constipation.
''Tylenol'': You may prefer an over-the-counter medication post-operatively.
== Post-Operative Recommendations <ref>Patel MN, Kaul SA, Laungani R, Eun D, Bhandari M, Menon M, Rogers CG. Retroperitoneal robotic renal surgery: technique and early results. J Robotic Surg, 3(1), 1-5, 2009.</ref>==
'''Diet'''<br />
When under anesthesia, your digestive system is put to rest.  Once awake, your digestive system may take some time to return to normal function.  As a precaution, your diet should be modified to avoid any foods that may irritate the lining of the stomach and cause abdominal discomfort or distention (bloating).  Foods that tend to cause irritation contain high amounts of fiber and should be avoided.  A soft diet is low in fiber, lightly seasoned, and easy to digest.  This diet should be followed until your first bowel movement occurs.  After that, high-fiber foods can slowly be reintroduced as tolerated.<br />
You can expect to have an intravenous catheter (IV) in for 1-2 days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated until you are able to tolerate a diet; in addition it provides a way to receive medications).  Most patients are able to tolerate liquids the day after surgery and advance to regular food by the next day.  Once on a regular diet, pain medication can be given by mouth instead of by IV.<br />
When you resume a regular diet, eat small frequent meals, aiming for 5-6 small meals per day.  Eat slowly and chew thoroughly.  Bloating may continue for 2-3 weeks after surgery and gas-producing foods such as onions, broccoli and/or bean products should be avoided.  Avoid lying down immediately after eating, allowing at least 30-60 minutes for digestion to reduce the risk of reflux.<br />
Avoid carbonated beverages and excessive dairy products during this time.<br />
<br />'''Activity Level'''<br />
It is good for you to walk around.  You can do as much walking and stair climbing as you can tolerate.<br />
Do not sit in one place for longer than 45 minutes at a time. <br />
Wait 4 weeks to resume biking, weight lifting, and resistant exercises such as abdominal crunches and leg squats. <br />
Do not lift, pull or push anything greater than 30lbs until 4 weeks after surgery.<br />
Light gym activity such as treadmill/elliptical, swimming, or golf are permitted at 3 weeks after surgery. <br />
You may take a shower 48 hours after surgery.  <br />
<br />'''Skin Integrity'''<br />
You will have about 4-6 port sites (small incisions that we perform the surgery through) that will have steri strips (small pieces of tape) and Band-Aids and/or dry gauze dressings over them.<br />
Band-Aids and dressings at navel area may come off in 48 hours. Steri strips may also come off as early as 48 hours post-surgery or they may stay in place until you are seen in clinic.<br />
Once your dressings are off, it is not uncommon to have a very small amount of drainage from where your dressings were.  There are generally no staples or stitches to be taken out.  You may use an over the counter antibiotic ointment on the small incisions once your dressings/Band-Aids are off.<br />
One port site may have a drain coming out of it.  When this drain is removed you will have a small hole that may drain for a few days.  Keep a dry gauze dressing over this area until it stops draining.  You may change it daily and more often as necessary.<br />
It is normal to have some bruising of the skin on your abdominal wall.  This can develop anywhere from 1-5 days out from surgery.  Although it can look scary, it is rarely anything to worry about and resolves in a few weeks.<br />
<br />'''Drain'''<br />
You may have a drainage tube that comes out of one of the port sites on your abdomen.  This will drain blood tinged fluid.  It is usually removed before discharge. You will be instructed on how to care for it and when it will be removed.<br />
<br />'''Urinary Catheter''' (also called a Foley Catheter)<br />
During surgery you will have a urinary catheter placed in your bladder. A urinary catheter is a tube carrying urine from your bladder to the outside of your body into a bag. This urinary catheter is usually removed 1-2 days after surgery.  It is not uncommon to have blood-tinged urine for a few days after surgery.<br />
                                                                                                                                                       
<br />'''Medications'''<br />
Resume all of your preoperative medications with the exception of blood-thinning medications such as aspirin, Plavix or Coumadin in addition to vitamins and supplements.  These may be resumed about 1 week after surgery.<br />
You will be given a narcotic prescription for your incisional pain, which you may need for a few days after discharge.  After that, Tylenol should be sufficient to control your pain.<br />
Continue a stool softener for 2 weeks after surgery.  All narcotic pain medications are constipating and a stool softener will help to prevent this.<br />
<br />'''Clothing'''<br />
After surgery, your abdomen will be bloated and it may be difficult to fit into your regular button pants. It is recommended that you wear elastic or draw-string waist pants for comfort.<br />
<br />'''Recovery Time'''<br />
The hospital stay usually lasts about 48 hours. This can vary, however, depending on how each individual recovers.<br />
You will be seen in the clinic (K-9) about 2-3 weeks following surgery.<br />
Many patients are able to return to light work within a few weeks after robotic kidney surgery, depending on the type of work.  Long-term disability is not necessary after this procedure since complications are rare and recovery is relatively short.  Any further time off will be recommended if medically necessary.<br />


== Post-Operative Complications ==
== Post-Operative Complications ==
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<br />
<br />
'''Bruising and Blisters around the incision sites'''<br />
'''Bruising and Blisters around the incision sites'''<br />
Not uncommon and should not alarm you.  This will resolve over time.<br />
Not uncommon and this will resolve over time.<br />
<br />
<br />
'''Abdominal Distention, Constipation or Nausea'''<br />
'''Abdominal Distention, Constipation or Nausea'''<br />

Revision as of 15:27, 7 August 2009


Template:Hangon Kidney surgery is traditionally performed as an open surgery, which requires a large incision and possibly removal of a rib, which causes greater pain. Robotic kidney surgery requires is minimally invasive because it uses robotic arms to perform the surgery.


How Robotic Kidney Surgery Works [1]

Conventional laparoscopy, robotic kidney surgery less invasive but limits the surgeon’s dexterity, visualization and control compared to open surgery. When performing a robotic kidney surgery, the surgeon sits at a console and controls the movements of miniature instruments and a tiny camera on the end of robotic arms inserted through several small incisions in the body. The robot cannot be programmed nor can it make decisions on its own; it is under the complete control of the surgeon at all times.

Precision
The precision and dexterity of the miniature robotic instruments allow the surgeon to perform complex steps of tumor resection and kidney reconstruction with greater accuracy.


3-Dimensional Optics
Standard laparoscopic surgery uses one single camera and limits a surgeon’s vision to a 2-D view similar to watching your television. Some robotic cameras consist of two high resolution fiber optic cameras which produce a 3-dimensional color picture for the surgeon. Magnification of up to twelve times can be achieved with these cameras, whose position is precisely controlled using a robotic arm.

Different Types of Robotic Kidney Surgery

Robotic Partial Nephrectomy[2]
Partial nephrectomy removes the kidney tumor while preserving the normal and unaffected portion of the kidney, thus preventing the loss of the entire kidney. The kidney tumor must be cut out precisely to ensure complete removal. The area of the kidney that has been cut out must be closed with complex surgical techniques. Robotic assistance can allow the surgeon to perform these complex steps with greater ease and precision. Robotic partial nephrectomy can provide a minimally invasive, kidney spariwng option for kidney tumors, avoiding the potential need for a total nephrectomy or open surgery An advantage of removing only the tumor from the kidney instead of removing the entire kidney is that the patient will have more normal kidney remaining, with a lower chance of long term kidney failure, dialysis, or other medical problems.


Robotic Radical Nephrectomy
Robotic surgery to remove the entire kidney for large tumors or disease involving the entire kidney.

Possible Advantages to Robotic Kidney Surgery [3]

• Less pain
• Fewer complications
• Shorter hospital stay
• Faster recovery
• Less scarring
• Less blood loss

Potential Risks and Complications [4]

Although complications are uncommon, there are risks and potential complications with any surgical procedure.

Bleeding resulting in hematoma or blood transfusion
Blood loss during this procedure is minimal and only rarely is a blood transfusion necessary. One of the many benefits of the robotic approach is minimal loss of blood. Because of this, we do not recommend donating your own blood before surgery.

Infection
All patients are treated with antibiotics prior to starting the surgery to decrease the chance of infection.

Hernia
Although uncommon, it is possible at the incision site.

Tissue/organ injury
Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery.

Conversion to open surgery
This surgical procedure may require conversion to the standard open operation if difficulty is encountered during the robotic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.

Urine leak
After a partial nephrectomy, you may have a drainage tube that comes out of one of the port sites on your abdomen that drains blood tinged fluid. It is usually removed before discharge. If persistent drainage occurs, you may go home with the drain and have it removed in your doctor’s office.

Post-Operative Complications

Post-operative Pain
Pain medication can be given in the hospital via an intravenous catheter or by medication taken by mouth or by an injection (pain shot) administered by the nursing staff. You may experience some minor transient shoulder pain (1-2 days) related to gas used in inflate your abdomen during the laparoscopic surgery. You will take oral pain medications as needed after discharge.

Bruising and Blisters around the incision sites
Not uncommon and this will resolve over time.

Abdominal Distention, Constipation or Nausea
You may experience sluggish bowels for several days. Make sure you are taking your stool softener as directed. If you don’t have a bowel movement or pass gas or are feeling uncomfortable 24 hours after surgery, you may try taking Milk of Magnesia (2-4 tbsp) as directed on the bottle. If this is ineffective you may use a Dulcolax suppository as directed. You may experience some nausea immediately after surgery related to the anesthesia. Medication is available to treat persistent nausea.

Weight Gain
Do not be alarmed. This is temporary due to the gas and fluid shifts. Your weight will return to normal 2-3 weeks after surgery.

Fatigue
This is common and should subside in a few weeks.

Lower leg/ankle swelling
This is not abnormal if it occurs in both legs. Elevating your legs should help. Call us if the swelling occurs in one leg or you experience calf pain.

Symptoms to Report

• Fever greater than 101º F
• Chills
• Nausea or Vomiting
• Dark red urine that does not clear with rest/fluids
• Severe abdominal cramps or spasms

See Also

Nephrectomy
da Vinci Surgical System

References

  1. ↑ http://www.kidneyrobotics.com/Kidney_Robotics/About_Robotic_Kidney_Surgery.html
  2. ↑ Patel MN, Bhandari M, Menon M, Rogers CG. Robotic assisted partial nephrectomy – Has it come of age? Indian Journal of Urology, in press.
  3. ↑ Patel MN, Bhandari M, Menon M, Rogers CG. Robotic assisted partial nephrectomy – Has it come of age? Indian Journal of Urology, in press.
  4. ↑ Patel MN, Menon M, Rogers CG. Robotic partial nephrectomy: benchmarks of laparoscopic partial nephrectomy to beat. Urol Oncol, in press.
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