Robotic Laparoscopic Partial or Radical Nephrectomy
This information will give you an overview of what to expect when you have a robotic-assisted laparoscopic kidney surgery. At your various clinic appointments and during your hospital stay you will be given additional information and detailed instructions on how to prepare yourself for surgery and how to care for yourself at home after surgery.
The information can sometimes feel overwhelming so it is a good idea to have a family member or friend involved in your care and come with you to your appointments. If you have any questions or concerns about your care, please feel free to speak with any of our staff.
Bring this information with you to every clinic appointment and hospital visit. Refer to it often so that you will know what to expect. Also try to write down your questions or concerns to help you remember to discuss them with us at your when you come in for your visits.
Pre-op appointments are usually scheduled within two weeks before the surgery. Pre-surgical clearance is required. If you have a history of heart disease, heart attack, or at risk for cardiovascular disease due to diabetes, high blood pressure and/or high cholesterol you may also need formal cardiology clearance. The testing can be done either at the hospital, or at your primary physician’s office. If you choose to have your testing at your primary doctor’s office, you will need to arrange for this appointment. We can provide them with the hospital’s requirements for surgical clearance. Typically these include a CBC, CMP, PT/PTT, Urinalysis, chest xray and EKG. For patients traveling from another state, pre-op appointments can also be coordinated with you local primary physician or alternatively can be arranged with the hospital a few days before surgery. Please fax all pre-operative test results to our office at (310) 854-0267.
The hospital will be contacting you directly to discuss the registration information for your stay. If you are going to have surgery at Cedars Sinai and need additional information, please call (310) 423-4068. For financial information with the hospital, please call (323) 866-7979. One of the clinic nurse will may ask you to sign forms for the surgery and tell you what to expect before and after surgery. In addition you may be asked to participate in a clinical trial. Clinical trials are important part of our mission to better help patients recover from their operation and find ways to help them increase their chance of cure from the cancer.
One week before surgery, stop taking these substances:
- Aspirin, ibuprofen (Advil, Motrin
- Green tea
- Herbal preparations and vitamin supplements including glucosamine
- Blood thinners such as coumadin and clopidogrel (Plavix) may need to be adjusted or stopped. Please discuss with your doctor.
- These substances can contribute to serious bleeding problems during surgery. Please discuss with your doctor if you have any questions.
- Please do not take any diet pills, dietary supplements, or any botanicals listed below one week prior to surgery:
- Gingko Biloa
- St John’s Wart
One to two days before surgery you should consume clear liquids. No milk or milk products are allowed. To avoid dehydration, try to drink 8-16 ounces of liquid each hour throughout the day. Tea, Gatorade, soft drinks, popsicles, coffee, jello, broth are allowed and will give you enough caloric nutrition prior to surgery. At 12 pm the day before surgery, you should consume 1 bottle of magnesium citrate, which can be purchased over the counter at your local pharmacy. You may have a result with bowel movements within 30 minutes to three hours of consuming the bottle. Every person is different and will have a result within a different time period. You do not need a prescription for this. If you have chronic renal disease please let us know about this, as it will be unsafe for you to take the magnesium citrate. You do not need to use an enema the day of surgery. It is very important that you do not eat or drink anything, not even water after midnight. Your procedure can be cancelled if you disregard this information.
On the day of surgery, in general, you may take these medications with a sip of water: Blood pressure, Heart, Stomach (ulcers, reflux), Seizures or epilepsy, and Asthma. Do not take diabetes mediation on the morning of surgery unless you are instructed to do so.
If any change in your general health occurs prior to your surgery (fever, cough, or cold), you should report it to us.
Arrange to have a responsible adult drive you to the hospital and home after discharge from the hospital. Under no circumstances, should you drive yourself home.
Please call our office at (310) 854-9898 for an appointment once you are discharged from the hospital. Patients after a routine robotic nephrectomy (partial/robotic) are seen within one week of the procedure to have blood drawn and have the port sites examined.
The pre-op nurse from the hospital will contact you between 3 and 8 p.m. the day before your surgery to let you know what time to arrive at the hospital. If your surgery is on a Monday, the nurse will call you on the Friday before.
It is important that we know how to contact you to let you know what time to come to the hospital. Please make sure we have up-to-date contact information, including cell phone number, hotel information and next of kin.
If the nurse has not called you by 8 p.m., please call: Cedars Sinai 310-423-4068
- Wear comfortable clothes and leave all jewelry and valuables at home.
- Bring a list of all your medications and any Advanced Directives for Health Care information if you have it (Living Will, Durable Power of Attorney for Health Care, or Advanced Directives for Health Care).
- For your hospital stay you may wish to bring slippers, boxer-type shorts and personal care items. Also bring a change of clothes for when you go home. These should be very loose fitting and comfortable since you will be bloated after surgery. Oversized sweat pants are a good choice.
The surgery typically takes about 2 1⁄2 to 3 hours.
A robotic-assisted partial nephrectomy patient will lose on average about 250 ml (about 8 ounces) of blood, which is 1/10 of what is traditionally lost in the open surgery.
The need for blood transfusion occurs in approximately one out of every 100 patients.
Catheter: You will have a catheter that goes into your bladder to drain urine. The catheter remains in place after surgery and is removed in one to two days and before discharge from the hospital.
Drain: You will also have a soft rubber drain, called a Jackson Pratt or “JP” drain that goes into your abdomen to drain excess fluid from the surgical area. This is usually removed before you go home.
Incisions: There will be four to six small incisions on your abdomen, including the drain site. These are where the surgical instruments were inserted. It is not uncommon for these small incisions to weep or leak either clear or bloody fluid. The drainage of these sites will typically resolve with time and does not require us to close them with any sutures. if there is a separation of the small incisions, they will heal on their own without significant impact on the cosmetic outcome. There are generally no staples or stitches to take out. You can apply an over-the-counter antibiotic ointment to the port sites once you are discharged from the hospital. If a drain is placed after surgery, once the drain is removed you will have a small opening that may leak fluid for a few days. Keep some dry gauze on this site until the drainage stops. Bruising and discoloration of the skin can develop within the first week of surgery. Bruising usually resolves with conservative management.
Diet: You will start with a clear liquid diet the day after surgery and then advance to a soft and subsequently regular diet as tolerated. Nothing other than ice chips is allowed to be consumed on the day of surgery. Do not rush to advance your diet, most patients after surgery will require a few days to resume normal bowel activity.
Activity: You will be able to get up out of bed and walk on the same day as surgery. Activity is encouraged and will speed your recovery.
Pain Management: Your nurse will closely monitor your pain level and work with you and your doctor to make sure you are as comfortable as possible.
Length of Stay: Most patients go home within one to two days after surgery.
YOUR HOSPITAL STAY
Patients are usually taken to medical/surgical ward and not the ICU.
Occasionally patients are taken to a monitored unit in the hospital if there are pre-existing heart condition that requires special monitoring. All rooms are private rooms and you will receive the same high quality care in any patient care unit.
Your nurse will teach you how to care for yourself when you are at home. This usually includes taking care of your small incisions and drain if you are discharged with one.
You will be taught what problems to watch for and how to get help if they occur.
It is always a good idea to include your spouse or another caregiver in the teaching sessions.
Patients are given prescriptions for pain medicine, a stool softener and sometimes an antibiotic when they go home. Follow the instructions for taking these medicines carefully.
We will tell you if you should continue, stop or change any of your other medications. If you have any questions, please ask.
HOME HEALTH NURSING CARE
If you need a home health nurse, your nurse case manager will arrange one for you before you go home.
SCHEDULING YOUR OFFICE APPOINTMENT
Your first clinic appointment will be within 7 days after your surgery.
This is general information on what you can expect after surgery. Your nurse will give you specific instructions before you go home.
Medications: You will get a list of medications to resume after your discharge from the hospital. If you have specific indications to be on aspirin or plavix such as a cardiac stent or history of stroke, check with us with regards to restarting the medication. Otherwise, it is safe to restart baby aspirin after your first postoperative visit.
All patients go home on pain medication and stool softeners. We suggest starting out with extra strength tylenol and supplementing with narcotic if you do not get adequate pain control.
Activity such as walking is encouraged and will speed your recovery.
Light exercise is also permitted, however, you should not lift anything over 8 lbs. (about the weight of a gallon of milk) until 4-6 weeks after the surgery. You should avoid any exercises that utitlize your abdominal muscles such as sit-ups and crunches as this will pre-dispose you to a hernia.
You should also avoid any movements that pull on your incisions or cause pain.
You may shower. This will not harm the catheter or incisions.
You may not take tub baths or soak in a hot tub until the catheter is removed and incisions are healed. This is typically 4 weeks after the operation.
There are usually no diet restrictions after this type of surgery.
We recommend that you avoid heavy meals until your bowel function is back to normal, usually after your first bowel movement after surgery. We suggest you start out by eating small frequent meals, by eating slow and chewing completely. You should also avoid laying flat after meals to reduce bloating and reduce the chance of reflux.
You should avoid gas-producing foods to reduce bloating. Even if you bowel habits prior to surgery are extremely regular with a bowel movement on a daily basis, you may require sometimes up to seven days to have a bowel movement. You may take laxatives such as milk of magnesia, stool softeners, a suppository or enema if needed. If you feel significant bloating, nausea, or vomiting, contact us for further instructions. Five percent of patients experience a slow return of bowel activity (called an ileum) from the anesthetic and light manipulation of the bowels. Sometimes this requires re-admission for IV fluids and bowel rest.
Driving: We do not recommend driving right after surgery especially while you have the catheter.
If you must drive, you must meet two criteria:
- You must not be taking pain medication.
- You should be able to slam on the brakes hard if needed.
PROBLEMS TO REPORT TO YOUR DOCTOR
- You have a fever of 101.3 F (38.5 C)
- You have persistent or large amounts of blood in your urine, drain or entry sites.
- Your catheter is not draining.
- You have any pus-like or foul smelling drainage. A small amount of whitish or greenish sediment on the incision is normal. If you have any hesitations, call our office or take a picture and email them to us for further instructions.
- You have continued nausea, vomiting or diarrhea.
- You have pain not relieved by medications, or your pain increases.
- You have pain or swelling in your legs.
- You have any questions or concerns.
First Clinic Appointment
First appointment within one to two weeks after your surgery.
We will discuss the results of the pathology report and what, if any further treatments are needed.
Returning to Work
When you return to work depends on the type of work you do and the rate of your recovery.
Many patients can return to work in three to four weeks depending on the type of work you do.
You will be scheduled for additional clinic appointments to monitor your progress and address any issues that may arise. You and I may also discuss additional treatments if necessary.