Hand-Assisted Laparoscopic Total Nephrectomy


A minimally invasive technique used to remove the entire kidney, a section of the tube leading to the bladder (ureter), the gland that sits atop the kidney (adrenal gland), and the fatty tissue surrounding the kidney.

Radical or total nephrectomy is the surgical removal of the kidney, the fat surrounding the kidney and the adrenal gland, which sits atop the kidney. A nephrectomy is a more involved procedure, which includes a radical nephrectomy plus removal of the entire ureter together with a cuff of bladder. This latter procedure is performed for a specific type of kidney cancer, a transitional cell carcinoma. In this type of cancer, the abnormal cells may also be present in the ureter, necessitating its removal.

A total nephrectomy is only recommended if a tumor is so large or in such a position that the entire kidney must be removed in order to deal with the tumor. In many cases, smaller tumors can be removed without sacrificing the entire kidney. These issues will be discussed with you before your surgery.

The Procedure

After the patient is asleep, he/she is then turned onto the side. 2-3 keyhole size incisions along with a small incision for the surgeons hand are made on the same side of the body as the kidney tumor.  Long instruments are inserted through these keyhole incisions. The surgeon watches inside of the abdomen on a television monitor. The blood vessels of the kidney and the ureter (the tube that drains the kidney to the bladder) are exposed, clipped and cut, and the kidney is released off all attachments. It is then placed into a bag, and pulled out through one of the incisions. This incision is extended to approximately 3-5”, depending on the size of the kidney and tumor. After the operation, the patient will feel much less pain compare to the conventional open surgery. This is mainly due to the small incisions made, but also, no large metal retractors are needed to keep the incision open, which contributes to less pain. Blood loss is almost always minimal; therefore patients will not likely require blood transfusion. Less pain translates to earlier recovery. The patient is given regular diet by the first day after surgery, and is encouraged to get out of bed and walk. Most patients stay in the hospital for 1-2 days, and usually are back to work within one month. This is in contrast to the open procedure, which the patients typically have an incisional scar of 7”-10”, and are hospitalized for 4-5 days, with a recovery time of approximately 6-12 weeks.