Robotic Partial Nephrectomy (Robotic assisted Laparoscopic Tumor Excision and Reconstruction)

What is a Robotic Partial Nephrectomy?
    The kidney tumor is excised and the remaining healthy kidney tissue is re-approximated using dissolvable stitches.

    When is this procedure done?
      Appropriate size and location kidney mass suspected of being cancerous

      How is the surgery performed?
        The surgery is a minimally invasive surgery performed through five or six small openings on the abdomen. The kidney, its blood supply, and the tumor are isolated. Inta-abdominal ultrasound is used to confirm the precise boarders of the tumor. The blood supply to the kidney is temporarily clamped and the tumor is excised. The healthy kidney tissue is re-approximated with a complex multi-layer repair.

        Where is the surgery performed?
          This procedure is an inpatient surgery (you will stay in the hospital for 2-3 days) performed at St. Mary’s Hospital Main Operating Room (second floor).

          What are possible risks from this surgery?
            · Bleeding (acute and delayed)
              · Infection
                · Damage to adjacent organs bowel, liver, spleen, pancreas, adrenal
                  · Urine leak, fistula
                    · Acute or chronic kidney injury
                      · Conversion to complete nephrectomy

                      Rare risks from surgery
                        · Blood clot in the legs or lungs
                          · Complications from anesthesia

                          What will be the recovery time?
                            Typical recovery for the procedure is 4 weeks. During the first week you will likely need to take pain pills which will likely make you feel tired and sleepy.

                            What are the advantages and disadvantages?
                              Advantages include:
                                · Smaller incisions than abdominal surgery (see picture below), decreased blood loss, less pain, and quicker healing time
                                  · Recent studies support that the procedure is as effective as traditional open surgery.
                                    Disadvantages include:
                                      · Technically challenging procedure for the surgeon.

                                      How do I prepare for surgery?
                                        Please contact Marilyn Turpin in Dr. Steele’s office at 706.612.9405
                                          If you have any medical problems, make sure that you are cleared for surgery. Make sure you have all necessary lab work, EKG, or chest x-rays done at least 3 days before surgery.

                                          Make sure your physician knows what medications, including herbal supplements, you are currently taking. Some medications need to be stopped for some time before the procedure:
                                            · Coumadin
                                              · Heparin
                                                · Motrin or ibuprofen
                                                  · Plavix
                                                    · Lovenox
                                                      · Aspirin
                                                        · St. John’s Wort

                                                        Smoking can affect your recovery. Smokers heal more slowly after surgery and may have difficulty breathing during the surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery.

                                                        Do I have any limitations afterward?
                                                          Walking: Normal physical activity is expected within hours of your procedure. Start with short walks and gradually increase the distance and length of time that you walk.
                                                            Climbing: Climbing stairs is permitted, but you may require some assistance initially.
                                                              Lifting: Please limit lifting to less than 10 pounds (approximately one gallon container) for 4-6 weeks.
                                                                Showers: Showers are allowed within 24 hours after your surgery. Refrain from baths for at least 1 week.
                                                                  Driving: Driving may be resumed 3-5 days after surgery, but be careful if taking prescription pain medications.
                                                                    Work: Most patients will be able to return to work between 3-4 weeks after surgery. Some patients may have residual fatigue for a couple weeks.
                                                                      Diet: No dietary restrictions unless diabetic. Regular food as tolerated.
                                                                        Pain: A pain medication will be prescribed for you after surgery. Do not take more frequently than indicated on the instructions.
                                                                          Drains and Wound care: You will have an abdominal drain after surgery which is generally removed prior to going home. In select cases, you may go home with the drain for one to two weeks. Minimal wound care is needed following robotic procedures. You may have a small amount of drainage from the site of your surgical drain after it is removed. This can be addressed with gauze and tape.

                                                                          Bowel Regimen: Following surgery use Miralax 17 g (one capful) daily until post op appointment to avoid constipation. If Miralax has not produced results within 4 days call office for instruction on possible use of milk of magnesia.

                                                                          How long after surgery do I come back to follow-up?
                                                                            At your pre-operative appointment, you will make a post op appointment with your physician between 4-6 weeks after surgery. .

                                                                            If you have questions following surgery, call our office at 706 612 9401 during normal working hours.

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