Laparascopy improves kidney removal procedures

with Alex Zacharias, M.D., Urologic Surgeon, Advanced Healthcare

Posted: April 1, 2005

Removal of a kidney or removal of any growth on a kidney can now be performed in a minimally invasive fashion with less pain.

Dr. Alex Zacharias, a urologic surgeon with Advanced Healthcare, performs laparoscopic removal of kidneys more frequently than the traditional open nephrectomy – or kidney removal operation.

“Traditionally, the removal of a kidney when a mass, growth or tumor was identified meant removing the kidney by making a 14 to 16 centimeter incision on the side, possibly removing a rib, exposing the kidney and its blood vessels, tying off these vessels before removing the kidney and then closing up the incision,” Dr. Zacharias said.

Alex Zacharias, M.D., Urologic Surgeon, Advanced Healthcare "The advantage to this procedure is that there are smaller incisions, minimal blood loss, less post-surgical pain, shorter hospitalizations and a faster recovery period."

The desire to cause as little pain as possible for healthy people voluntarily donating their kidney to save another life by transplantation spurred the development of hand-assisted laparascopic nephrectomy. The use of laparoscopy to assist in removal of kidneys from living kidney donors and the experience gained from this is now used to remove diseased kidneys.

The laparoscope made it possible to perform surgery through small incisions.
“But to remove a kidney purely laparascopically can be very difficult,” Dr. Zacharias said, “because a kidney measures from 12 to 14 centimeters in size.”

Since 2000, Dr. Zacharias has been performing the hand-assisted procedure in full and partial nephrectomies — removal of just the tumor from the kidney.

In hand-assisted laparascopic nephrectomy, Dr. Zacharias places his hand inside the abdomen, using a special device which allows him to create an air space, or pneumoperitoinium.

A small incision, about 5 to 6 centimeters, allows space for his hand; two small additional incisions are made in order to place two small laparascopic ports nearby. The ports allow the doctor to view the abdominal cavity on an external camera.

Using his hand, the camera, and working instrument such as cautery or scissors, a surgeon can expose the kidney from all of its attachments and staple off the blood vessels with a surgical stapler, and extract the kidney through the largest of the incisions.

“This approach allows you to remove a kidney in a fairly short period of time, about two and one-half hours,” Dr. Zacharias said. “The advantage to this procedure is that there are smaller incisions, minimal blood loss, less post-surgical pain, shorter hospitalizations, and a faster recovery period.”

That said, the procedure, which he’s been performing on an average of four or five cases a month since 2000, is not for everyone.

“People who have had previous abdominal or bowel surgery may not be good candidates for this procedure,” he said. That’s because bowel adhesions can form, making it hard for the surgeon to see using the scope.

In addition, patients with tumors larger than 9-10 centimeters on the kidney are better served by undergoing the open procedure. If the tumor is smaller than 4 centimeters and depending on its location on the kidney, Dr. Zacharias said, an effort to try to save the kidney, and only remove the tumor, would be the best approach.

According to the American Cancer Society, kidney cancer accounts for approximately 3 percent of all adult cancers, with about 32,000 new cases diagnosed each year. It occurs in people who are over the age of 40, and affects men more than it does women.

Most of his patients, he said, are diagnosed after coming in to see him because of blood in their urine, abdominal pain, or a routine X-ray or scan that picked up the early growth of a tumor. Many can remain silent until they grow to a very large size. But most tumors on the kidney are still contained at the time of diagnosis.

Dr. Alex Zacharias
Good Hope Road Clinic
3003 West Good Hope Rd.
Milwaukee, WI 53209
414-352-3100

East Mequon Clinic
12203 N. Corporate Pkwy
Mequon, WI 53092
262-387-8200

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