Eastern Shore Urology Associates Experienced Urologists Talbot County, Maryland

Hand assisted laparoscopic surgery allows the surgeon to perform technically challenging surgery through small incisions resulting in minimal post-operative pain and rapid return to normal activity.

Hand assisted laparoscopic surgery allows for the removal of the entire kidney, part of the kidney, adrenal tumors, or the entire kidney, ureter, and urinary bladder cuff for bladder cancer in the kidney and ureter. This is one of the newest surgical treatments for urologic cancers. Previously, this type of surgery was performed through a 12 to 18 inch incision and required hospital stays of up to one week due to pain and morbidity. Compared to conventional open surgery, laparoscopic surgery results in less pain, shorter hospital stay, earlier return to work, and a better cosmetic result.

Hand assisted laparoscopic surgery allows the surgeon to remove the tumor and necessary tissues by inserting his hand into the abdomen through a small seven centimeter incision. This allows the surgeon to manually manipulate the organ and provides the surgeon with critical tactile information that is missing in standard laparoscopic procedures. This incision also allows the surgeon to remove the kidney intact within a bag at the end of the procedure. Intact removal of the kidney or tumor allows the pathologist to accurately size and stage the tumor as well as determine the surgical margins, something that cannot be done with morcellation of the tumor in some traditional laparoscopic surgery. Hospital stays after hand assisted laparoscopic surgery average two days and patients return to normal activity in one to two weeks.

Potential risks and complications

Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include:

• Bleeding: Blood loss during this procedure is possible, and a transfusion is needed in 5% of patients. If you are interested in autologous blood transfusion (donating your own blood) you must make your surgeon aware.
• Infection: All patients are treated with intravenous antibiotics prior to starting surgery to decrease the chance of infection occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage incision, urinary frequency/discomfort, pain, or anything that you may be concerned about) please contact us at once.
• 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. Injury could occur to nerves or muscles related to positioning. Hernia at incision site is a possibility.
• Hernia: Hernias at incision sites rarely occur since all laparoscopic incisions are closed under direct laparoscopic vision.
• Conversion to open surgery: The surgical procedure may require conversion to the standard open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.

What to expect after the surgery

Immediately after the surgery you will be taken to the recovery room and transferred to your hospital room once you are fully awake and your vital signs are stable.

• Postoperative Pain: Pain medication can be controlled and delivered by the patient via an epidural or an intravenous catheter or by injection (pain shot) administered by the nursing staff. You may experience some minor transient shoulder pain (1-2 days) related to the gas used to inflate your abdomen during the laparoscopic surgery.
• Nausea: You may experience some nausea related to the anesthesia. Medication is available to treat persistent nausea.
• Urinary Catheter: You can expect to have a urinary catheter draining your bladder (placed in the operating room while the patient is asleep) for approximately one day after the surgery. It is not uncommon to have blood-tinged urine for a few days after your surgery.
• Diet: 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; in addition it provides a way to receive medication.) Most patients are able to tolerate ice chips and small sips of liquids the day of the surgery and regular food the next day. Once on a regular diet, pain medication will be taken by mouth instead of by IV or shot.
• Fatigue: Fatigue is common and should start to subside in a few weeks.
• Incentive Spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to you during your hospital stay). Coughing and deep breathing is an important part of your recuperation and helps prevent pneumonia and other pulmonary complications.
• Ambulation: On the day of surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can expect to have SCD's (sequential compression devices) along with tight white stocking legs to prevent blood clots from forming in your legs.
• Hospital Stay: The length of hospital stay for most patients is approximately two days. Constipation: You may experience sluggish bowels for several days or several weeks. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of mineral oil daily at home will also help to prevent constipation.

What to expect after discharge from the hospital

• Pain Control: You can expect to have some incisional discomfort that may require pain medication for a few days after discharge, after which Tylenol® should be sufficient to control your pain.
• Showering: You may shower at home. Your wound sites can get wet but must be padded dry. Tub baths can soak your incisions and therefore are not recommended in the first two weeks after surgery. You will have adhesive strips across your incisions. They will fall off in approximately 5-7 days on their own. Sutures underneath the skin will dissolve in 4-6 weeks.
• Activity: Taking walks is advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible. Driving should be avoided for at least 1-2 weeks after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) for six weeks or until instructed by your doctor. Most patients return to full activity at home on an average of three weeks after surgery. You can expect to return to work in approximately four weeks.
• Diet: You should be on a no added salt diet and always avoid high protein diets.
• Follow-up Appointment: You will need to call Dr. Runz's office at 410.822.5552 after hospital discharge to be seen in the office in 1-2 weeks.

Eastern Shore Urology Associates, PA

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