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Which is a better or safer open or Lap ... Here IS THE UPDATE AFTERMATH!!!!!!!!!!!! HELP SOMEONE PLEASE!!

acole1's picture
acole1
Posts: 7
Joined: Dec 2014

Hello all, I go for a partial nep surgery next week and wanted to know if anyone can give me some insight on which surgery is safer. 

The open surgery or the Lap.

 

Hello all, an official club member... But I have a question. I had surgery Dec. 19th and  sad to say I'm still in the Hospital 9 days later with a servere urine leak from the incision ( which leads me to ask is urine leakage normal.)

 Also what are some question and or information i need to be asking the Dr. for.

 

jason.2835
Posts: 337
Joined: Nov 2014

From what I've read, it all depends on the surgeon. Lap seems to be the far better choice in terms of pain and recovery time, however not all surgeons are proficient in it. Older surgeons are set in their ways. It really depends on who you see. Personally, I'd find a way to talk to a surgeon who can do laparoscopic surgery; they may be younger, but your recovery time will be so much less. My surgeon was not only proficient in lap but also the robotic version, which is even less invasive and more precise. If your only choice was an older surgeon who preferred open, it's not that it's not safe. It's just a better way has been invented. 

icemantoo's picture
icemantoo
Posts: 3255
Joined: Jan 2010

Whether its open or lap depends on the surgeon, the size of your tumor, its location and your medical history.

Sometimes it starts as a lap and in the middle of the inning they make a game time decision to go open. There are top notch surgeons who only do open.

 

Good luck either way and may it be an uneventful surgery.

 

Icemantoo

nsb748's picture
nsb748
Posts: 90
Joined: Feb 2014

Per my surgeon, there are unique risks to each.

For example, a lap generally goes in through the front.  This means that they are in close proximity to other organs, which can cause issues like perforations.  (but very slim chance, and as long as they know about them, not a huge deal.)

An open surgery obviously is a much bigger wound, but it is basically an express route to the kidney.  (unless they have to remove a rib like they did for me)

 

Lap is quicker healing, and supposedly less painful.  I have only had the open surgery, but my doctor said that from feedback he has received...

On a scale of 1-10, if an open surgery is a 7,  a lap surgery is like a 5. 

 

Open is easier access and more maneuverability. 

Lap is the future though.  My surgeon who did my open surgery said that if he was a little younger, he would definitely learn to use the davinci and do lap surgeries.  He also said that if he had to choose, he would have a lap surgery himself. 

APny's picture
APny
Posts: 1981
Joined: Mar 2014

There are a couple of misconceptions. One is that those who don’t do it are not skilled, and second, that your wound is significantly larger. Neither is really true. My surgeon at Sloan Kettering convinced me that the open is a better procedure because he can see and feel the kidney, as well as control any bleeding etc. should it occur. He’s a widely published and cited expert on kidney cancer and surgery and obviously has the skill to do one should he wish to do so. He chooses not to for his own professional reasons. As for incision, my partial nephrectomy was open and my incision is barely over four inches, so it’s not necessarily true that the incision will be larger. I recovered quickly and was out of the hospital in two days.

acole1's picture
acole1
Posts: 7
Joined: Dec 2014

Thank you for all the information

AndyE
Posts: 51
Joined: Nov 2014

I am scheduled for a partial on Monday, and the procedure will be open.  The doctor told me that in order to remove the tumor in a single piece, a somewhat larger incision would have to be made whether the surgery was open or lap.  I guess he inserts some sort of bag on a tool, bags the tumor, seals the bag, and then removes the tumor incased in a bag to minimize the chances of cancer cells spreading during extraction.  In order to do this, he said a 4-6 inch incision would need to be made in addition to the smaller laproscopic incisions.  An open procedure would require a 5-7 inch incision, but I wont have the smaller holes in addition.  He convinced me that the open procedure was by far the better option in my case.  My opinion is that you should choose (or the doctor should recommend) the procedure that he/she is most familiar with and trained in, and the one that gives you the best chance of full recovery.  Post surgery pain will surely be there regardless of which road you take, but it is hopefully a temporary inconvenience for a long-term gain.

myoung790
Posts: 75
Joined: Sep 2014

I think it's all perspective and surgeon comfort level.  My surgeon told me that technique would not matter regardless.  

nsb748's picture
nsb748
Posts: 90
Joined: Feb 2014

My surgeon told me that success rates are virtually identical, as are the risk of complications. 

 

His practice has guys who do both types, and I was given an option.  I chose open because I prefer my mechanic to go in through the hood rather than the dashboard. 

It really doesn't matter, I just felt better about it knowing that he was in there looking around a little bit.  

 

My incision is 6-7 inches, and because of where my kidney resides (higher than expected?) I had to get my second to last rib removed. 

APny's picture
APny
Posts: 1981
Joined: Mar 2014

"I chose open because I prefer my mechanic to go in through the hood rather than the dashboard. "

 

I love that! I prefer that myself Smile

acole1's picture
acole1
Posts: 7
Joined: Dec 2014

I went in on the 19th to have the Open Partial.. here it is 9 days past Surgery and I'm am still in the Hospital. There is leakage coming from the incision wound like a running faucet that they can't seem to stop. A 4ccm turmor was removed from the bottom of my left solitary Kidney. Do anyone have any advice on what questions I need to be asking or what needs to be done. 

I'm 45 yrs older no pryor health issues  besides High Blood Pressure and in pretty good shape.

Any insight will be helpful

Jan4you's picture
Jan4you
Posts: 1325
Joined: Oct 2013

Oh dear, I am sorry this is happening. I am not familiar enough to know what to ask.

Maybe others will know.

But.. I WILL be thinking/praying for you to heal up and get home soon!

Let us know how you are doing. Okay?

Hang in there.

Hugs, Jan

acole1's picture
acole1
Posts: 7
Joined: Dec 2014

I will just just keep floating around. Hopefully this will end soon.

a_oaklee
Posts: 516
Joined: Nov 2013

Re the drainage you are experiencing:  Are any medical professionals concerned?  Is that the reason that you are still hospitalized?  When my husband had his complete nephrectomy he had a drainage tube in place.  at the end of the tubing was an egg shaped bulb that collected the fluid.  There was a valve on it to empty as it filled.  Some patients have gone home with them and have them removed later.  My husbands was removed before he went home.   It makes me think that fluid accumulation must be normal.  I am not an expert.   I do hope you get some answers and that you will be home soon.

nsb748's picture
nsb748
Posts: 90
Joined: Feb 2014

I had a drainage tube when I left the hospital like the one you describe. 

I had to go in to my surgeon's office and get it removed in 2 or 3 days.  According to a few people including my surgeon, they like to avoid having a patient leave with a drain in place if at all possible. 

Apparently the drain is a site that can get infected easily.  On a side note...  When they take that thing out, it is a very strange feeling.  It is in there a lot further than you would think. 

Jroberts1157
Posts: 1
Joined: Dec 2014

Hello,

I have had bilateral kidney cancer since 2007.  I have had both lathroscopic and open partial nephrectomy.  Based on my experience and according to what I trust is the best doctor ( Cleveland clinic).  Urinary leakage is a bit normal in most cases.  I had a leak after my second surgery and had to have a port put in and I had that port to drain the urine.  I had it for  a month.  But after that I was much better!  I am 37 years old.

APny's picture
APny
Posts: 1981
Joined: Mar 2014

I came home with a drain, which I had to empty and measure every day. It was in for a week. I was meticulous about it because of risk of infection. And yes, removing it felt very weird. Is your leakage urine, blood, a mix of both? Or is it an infection draining? I'm so sorry you're going through this but it will stop and you'll be home soon. Sending you good thoughts and prayers.

acole1's picture
acole1
Posts: 7
Joined: Dec 2014

I have what they call a wound bagging with a drain plug to  cover the incision  in which it is leaking urine only from. I do not have a drain tube inbedded intome. should I be asking about this?I am also stuck with a catheir.. What should I do.

APny's picture
APny
Posts: 1981
Joined: Mar 2014

Yes, I would ask about the catheter and how long it needs to remain in there. Also I'd ask about the urine leakage and how that could be corrected. Have you spoken with your surgeon? Hang in there; it WILL get better.

acole1's picture
acole1
Posts: 7
Joined: Dec 2014

I spoke to my surgeon he informed me that it was a 4ccm tumor  it was (Cancer) staging was pt1 and that it was removed with 0 margin and there are no signs of it anywhere else in the body. As for as the leakage it is part of the process for some patients and that it will still in a few days of so.. that tissue has to seal it self becase of the position of the tumor.. Also the Catheter will be there until the leakage subside.. GOOD NEWS is that fact the I'm alive and have another chance at life.

AndyE
Posts: 51
Joined: Nov 2014

This sounds very similar to my situation. I had an open partial performed almost 3 weeks ago, and the tumor was almost 5 cm.  Like yours, my surgeon removed it with clear margins and saw no evidence of it having spread.  He said it appears to be a stage 1 tumor, but pathology hasn't come back yet.  I will have the chance to review pathology with him on January 8, and at that point will learn the true stage and grade of the tumor.  Also like you I had a catheter (drain tube) in my side following surgery.  This is a normal part of the procedure, as your body will most likely produce more fluid than it can absorb after surgery.  The tube helps to rid your body of this excess drainage until it subsides...in my case, I had surgery on Monday and the tube was removed Thursday morning.  I will tell you that having the tube removed is...um....interesting.  It is the strangest feeling, or at least it was for me, and somewhat uncomfortable.  It is, however, a small price to pay for the second chance at life as you stated.  Congrats on your successful surgery, and my best to you for a speedy and complete recovery.

 

Andy

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