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Medical Edge Newspaper Column from Mayo Clinic

‘HANDS ON’ KIDNEY SURGERY HAS QUICKER RECOVERY RATE

DEAR MAYO CLINIC: I am supposed to begin a new teaching job and I just learned I have a golf-ball sized tumor on my kidney that requires my kidney to be removed. My wife talked to a man in a spousal support group about his wife’s recovery and learned she spent 10 days in the ICU and another 10 weeks at home before she returned to work!

Then I read on the Internet of a faster recovery time and less pain with a new kind of “hands-on” surgery, in which the kidney is removed by hands, not scalpels. Is this experimental, and can it actually spread the cancer? I went to school at night for years for this second career and want to pull my weight right off the bat. Will I be able to with just one kidney? — Baton Rouge, La.

ANSWER: The procedure you read about is called hand-assisted laparoscopic nephrectomy (kidney removal), and it was developed in the late 1990s. After about five years of evaluating this procedure, researchers have found it to be as effective as the standard procedure for removing the kidney in cases of tumors and rare cancers that are 1 to 6 inches in diameter.

There was initial concern that manipulating the kidney by hand might spill tumor cells and contaminate the surgical site, But after conducting more than 150 procedures at our institution alone, we have determined this is not happening.

This approach is “hands on” in the sense that the surgeon inserts a gloved hand into the surgical opening to work with the laparoscopic instruments and remove the diseased kidney. The surgical cuts made for the laparoscopic instruments and the hand are at least half the size of the standard 8-to-10 inch incision made in the abdomen. A smaller incision means less trauma on your body. And less trauma translates into less postoperative pain, a shorter hospital stay and a shorter recovery at home.

In addition to the patient benefits of an easier and faster recovery, surgeons benefit from using the hand as a surgical instrument. Unlike metal instruments, a hand can give important tactile information that aids and expedites the operation. When performed by an experienced medical team on a carefully selected patient, hand-assisted laparoscopic nephrectomy offers the best of both surgical approaches — the good cure rate of the standard, large-incision approach, and the quicker recovery from a smaller incision.

Patients who undergo hand-assisted laparoscopic nephrectomy usually spend one to three nights in the hospital, then recuperate at home for two to four weeks before returning to work.

You should put your body’s need to heal ahead of your urge to work. By about the third or fourth week at home, you should feel comfortable moving and lifting light loads. Most patients with office jobs find they are able to resume a reasonable workload within a month of a hand-assisted procedure.

A person normally has two kidneys, one on each side of the spine in the back of the abdomen. Each is about the size of a small adult fist. Together they cleanse and purify about 425 gallons of blood a day through 2 million tiny filters called nephrons. They also regulate blood volume; recycle water, minerals and nutrients; and make sure blood has the correct chemical composition.

The body is able to do all this with just one healthy kidney. Prudent diet, exercise and rest will help preserve the kidney’s ability to do its amazing work.

Michael Wehle, M.D., Urology, Mayo Clinic, Jacksonville, Fla.

Additional Resources:
Hand-Assisted Laparoscopic Nephrectomy
Appointment Information

READERS: If hot flashes leave you drenched, you do have treatment options. Estrogen remains the most effective way to reduce or eliminate hot flashes. While research has shown that there are associated health risks, it’s still an option. But nonhormonal options are also available.

A Mayo Clinic study found that low doses of the antidepressant drug venlafaxine (Effexor) can reduce the number of hot flashes by about 60 percent, with minimal side effects. Studies using other antidepressants have shown similar results. Other studies have demonstrated that an antiseizure medication, gabapentin, also relieves hot flashes to a similar degree.

Additional Resources:
Treatment Hot Flashes
Appointment Information
More Information on Hot Flashes
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.