What is Robot Assisted Nephrectomy

Robot assisted nephrectomy is a surgical procedure to remove all of your kidney (radical nephrectomy) or part of your kidney (partial nephrectomy). During this procedure, small cuts (incisions) are made in the abdomen. Instruments and a telescope with a camera will be attached to a surgical robot.

A surgeon will control this robot from a console. The surgeon will see all sides (three-dimensional view) of the inside of your body.

You may need this procedure if you have kidney cancer, are donating a kidney, or have a damaged or diseased kidney.

Let your health care provider know about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Pneumonia.
• Damage to other body structures near your kidney.
• Allergic reactions to medicines.
• Leaking of urine into your abdomen, which may require surgical drainage or repair.
• A blood clot that forms in your leg, breaks free, and travels to your lung.
• Failure of remaining kidney function, which may require kidney dialysis.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

• Follow instructions from your health care provider about eating and drinking, which may include:
  • 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be asked to take a medicine that helps you have a bowel movement (laxative) to clear out your colon.

General instructions

• Plan to have someone take you home from the hospital or clinic.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Ask your health care provider how your surgical site will be marked or identified.
• You will have:
  • A physical exam.
  • Blood tests and urine tests.
  • A test of your heart (electrocardiogram or ECG).
  • Imaging of your kidney.
  • An interview with your anesthesia team.
• Ask your health care provider what steps will be taken to prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A tube will be placed in your bladder (catheter) to drain urine.
• A tube will be placed through your nose and down into your stomach (nasogastric tube) to drain stomach juices.
• Your health care provider will make 4 to 6 small cuts (incisions) in your abdomen. Operating instruments will be inserted through these incisions.
• Your abdomen will be filled with carbon dioxide gas. This makes it easy for your health care provider to see inside your abdomen.
• Your health care provider will do the procedure by controlling instruments that are attached to a robot.
• Your kidney will be detached from the surrounding tissues.
• For partial nephrectomy:
  • The blood vessels attached to your kidney will be clamped.
  • Part of your kidney will be removed, the kidney will be closed with sutures, and the clamp on the blood vessels will be removed.
• For radical nephrectomy:
  • The blood vessels attached to your kidney will be closed and cut.
  • The whole kidney will be removed, along with part of the tube that carries urine to your bladder (ureter).
  • If you have kidney cancer, the gland on top of your kidney (adrenal gland), fat surrounding your kidney, and any lymph nodes near your kidney may also be removed.
• After part or all of the kidney is removed:
  • All the instruments will be removed from your body.
  • A small tube (drain) may be placed near one of the incisions to drain extra fluid from the surgical area.
  • The incisions may be closed with sutures, staples, or tape.
  • A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• Your nasogastric tube will be removed.
• You may continue to have:
  • An IV until you can drink fluids on your own.
  • A urinary catheter.
  • A drain.
  • Pain medicine through your IV.
• You will be encouraged to:
  • Get out of bed and walk when able.
  • Do deep breathing exercises and cough to prevent pneumonia.
• You will be started on a liquid diet at first. Ask your health care provider when you can resume your regular diet.

Summary

• Robot-assisted nephrectomy is a surgical procedure that uses instruments and a robot to remove all or part of your kidney.
• This procedure is done under general anesthesia.
• During this procedure, small incisions are made in your abdomen. Instruments and a telescope with a camera will be attached to a surgical robot that your surgeon will control.

Robot-Assisted Nephrectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Soreness and numbness in your incision areas.

Follow these instructions at home:

Eating and drinking

• Eat foods that are high in fiber to prevent constipation. Get plenty of fresh fruits and vegetables, whole grains, and beans.
• Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
• Drink enough fluid to keep your urine pale yellow.

Activity

• Get up and walk around as told by your health care provider. This is important to help prevent blood clots.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you. It may take about 6 weeks until you can return to full activity.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Do not play contact sports. Doing so may damage your remaining kidney.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• If you have a drain, follow instructions from your health care provider about how to care for it.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

• A fever or chills.
• Pain that is not controlled by your pain medicine.
• Redness, swelling, or pain at your incision site.
• A bad smell coming from the wound or dressing.
• Blood in your urine.
• Not had a bowel movement in 3 days.

Get help right away if you have:

• Warmth, redness, and tenderness in your leg.
• Trouble breathing or feel short of breath.
• Fluid, blood, or pus coming from an incision.

Summary

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.
• Check your incision areas every day for signs of infection.