Removal Of Kidney (Nephrectomy)

This morning after I awoke, I felt really uncomfortable. My senses feel dull and the first thing that came to my mind was to quickly detox. However, I chose to go for my qi gong class first but halfway through my class, I decided to take leave from my teaches and headed for home. I need to detox quickly for I think that is the best option for me to get back to normalcy.

I have been researching more on laparoscopic surgery, also called minimally invasive surgery or keyhole surgery is a modern surgical technique in which operations in the abdomen such as removal of the kidney (nephrectomy). are performed through small incisions (usually 0.5–1.5 cm but can be 10cm) as compared to larger incisions needed in traditional surgical (usually 20cm) procedures. With the assistance of my sister, who spoke to another urologist (5th doctor) at a nearby hospital where I live, I got more information. Earlier I was given the impression by the 3rd urologist that he will try to perform the laparoscopic surgery and if it not possible, to convery to a full surgery. At that time, the size of my tumor was 14cm. However, this 5th urologist said larparoscopic surgery, the incision is performed on the back while normal surgery, the incision is in front. So it would not be possible to convert a laparsocopic surgery to a full sugery unless they have two incisions on the back and front of my abdomen. Furthermore, if the size of the tumor exceeds 5cm, it is too dangerous to be performing the laparoscopic surgery as the area around the kidney are mainly nerves and blood vessels. Below are the summary of what my urologists said:

1st Urologist
There is nothing I can do for you. Even if surgery is performed, as the cancer has spread to the lungs it would not help you.

2nd Urologist
The are indications that the tumor may have also invaded the liver. The surgery is going to be very risky as it may involve multiple organs and you may die at the operation table. Even if you survive, there may be post surgery complications and you may need to wear tubes.

3rd Urologist
Very optimistic that the surgery can be performed. If the liver is invaded, he will not touch it and only remove the kidney tumor. Will try laparscopic surgery and if not possible will convert to full surgery. Did not tell if incision was in front or back.

4th Urologist
Surgery can be perofmred but may not be useful. Most of his patients died within 6 months of surgery. Did not recommend for me to proceed, so did not explore anything further.

5th Urologist
Doctor has no benefit of viewing the CT scans as it was just a preliminary enquiry. Any tumor greater than 5cm is not recommended to perform laparoscopic surgery. Also, laparoscopic surgery's incision is performed on the back while full surgery's incision is in front, so it is not possible to convert the surgery halfway.

As you can see, there are variations in opinions and sometimes the doctor did not (purposely or otherwise) tell all. Perhaps it was my lack of understanding on this surgical technique not to ask the correct questions. This is why reading is so important, you just cannot rely 100% on your doctors. What I read from Wikipedia is that many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons that choose this hand-assist technique feel it reduces operative time significantly vs. the straight laparoscopic approach, as well as providing them more options in dealing with unexpected adverse events (i.e. uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.

If you look at the diagram on the left, you will notice the incision is carried out on the back. Further reading of what Wikipedia have to say, I am wondering if the 5th urologist is also correct after all? Perhaps, it is the doctor's perogrative where the incision is to be made. This calls for more reading but at least now, I have a better feel and understadning of the subject matter and I can ask the correct questions when I meet the two doctors (3rd and 5th urologists) and I intend to use one of them should I go ahead with the surgery. Looks like hand-assisted laparoscopic surgey is a possibility and a good news for me. The only question is does he know that procedure?

Why am I so keen on laparoscopic surgery? The advantages includes reduced post operational pain due to smaller incisions and hemorrhaging, and shorter recovery time. Bearing in mind what the 4th urologist said, I stand a better chance as the body is not so weakened by the surgery.