Robotic Assisted Partial Nephrectomy

What is a kidney?

The kidneys are bean shaped organs located in the upper back of the abdomen, each about the size of a fist. The kidneys are vital organs that filter water and other waste products from your blood. They regulate hormones and mineral levels in your bloodstream.

What is a robotic assisted partial nephrectomy?

A robotic partial nephrectomy is a surgical procedure to remove part of the kidney, usually for a small tumour. The tumour is removed by using small keyhole instruments attached to a robotic system. The robotic camera and instrument bearing arms are inserted through small incisions in the abdomen.

In a partial nephrectomy, only the diseased or injured portion of the kidney is removed. A partial nephrectomy may require you to have a ureteric stent for a period of time. A stent is a thin hollow tube inserted into your ureter during your procedure to aid with the draining of urine from your kidneys to your bladder.

Potential benefits of a robotic operation

Before the procedure

Please sign the consent form that gives your permission to perform the operation. Read the form carefully and ask questions if something isn’t clear. Take the admission booklet to the hospital to book the operation.
In addition to a complete medical history, your doctor may perform a physical examination to ensure you are in good health before you undergo the procedure. You may also undergo further blood tests and other diagnostic tests.
You will be asked to fast for at least 6 hours before the procedure, generally after midnight. The hospital will call the day before to advise when to stop eating and when to come into the hospital.
Inform your doctor if you are allergic to any medications, latex, tape and anesthetic agents.
Inform your doctor of all medications (prescribed and over the counter) and herbal supplements.
Notify your doctor if you have a history of bleeding disorders or if you’re taking any anticoagulant (blood-thinning) medications, aspirin, other medications or herbal preparations that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you smoke, you should stop smoking as soon as possible prior to the procedure in order to improve your chances for a successful recovery from surgery and to improve your overall health status.

Operation Day

You will be given intravenous fluids and anaesthetised for your surgery. Usually, the anaesthetic doctor will see you or speak to you over the phone beforehand.
After the operation you will return to the ward with intravenous fluids with pain relief you can independently administer when needed. This is called patient controlled analgesia (PCA).
Small adhesive abdominal dressings will be placed over the incision sites and a small drain which will be removed in the next few days. The dressings may be changed before discharge.
You will have a urinary catheter draining the bladder for a few days until you are drinking adequately. It is common to have blood in the urine and the catheter will be removed for a trial of void before discharge.
Tight stockings will be placed on your calves to prevent the formation of clots.
Sitting out of bed and walking short distances around the ward will also help prevent clots. Deep breathing and coughing exercises is recommended to help prevent collapse of the lungs.

After discharge

Wound Care

You may experience some discomfort for a few days when returning home to resume normal activities. Take pain relief as prescribed or recommended on discharge.
The dressings are usually water-resistant and you can shower normally.
Keep your dressings intact if possible. You can remove or change dressings if required e.g. if peeling, moist or lifting
The sutures are dissolvable.
Call Lake Macquarie Urology if you have any problems with your wounds.

Blood in the urine is common for a few weeks after the procedure. Increase water intake (1.5-2.0L) to try to keep the urine clear. If you develop a fever, chills, uncontrollable shaking (rigors) or burning when passing urine, you may have an infection and should seek medical attention. Please attend Lake Macquarie Private Hospital Emergency if insured or your nearest emergency department if this occurs. Our specialist urology nurses are usually available for phone advice during working hours.

Bowel Care

It is common for your appetite and bowel movements to recover gradually in the first week after surgery. Bowel movements may not resume until 3-5 days and is often a combination of change in diet, the operation and pain relief medications.
Try to avoid constipation. Drink plenty of water and if necessary take laxatives such as Metamucil, Coloxyl or Movicol as directed. Many of these can be bought over the counter at your pharmacy.

Activity Restrictions

It is expected that you will resume gentle activities around your home after you have been discharged from hospital. Gradually, increase the amount of walking you do each day, as tolerated. Do not walk to the point of exhaustion and avoid heavy lifting (<5kg). We recommend that you wear your anti-embolic stockings until you are as active as you were before surgery.

Follow-up Call

A nurse will provide a follow-up call to you after the operation. It is a good idea to write down anything you want to ask and have it ready. An appointment will be arranged for you to see your surgeon in the rooms approximately 4 weeks after the operation. Please ring our staff if you have any questions or concerns.