The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic nephrectomy (including nephroureterectomy).
Indications for nephrectomy include kidney cancer, severe trauma to the kidney and benign disease such as symptomatic hydronephrosis, chronic infection, polycystic kidney disease, shrunken kidney, hypertension or renal calculus. The most common type of kidney cancer is renal cell cancer. Other types include Wilm’s tumour (a childhood cancer) and transitional cell cancer.
The standard treatment for an irreversibly damaged kidney or localised kidney cancer is an open nephrectomy. Under general anaesthesia, the kidney is removed through a large incision that may be made in the side of the body, in the front of the abdomen or in the back. A simple nephrectomy is the removal of just the kidney whereas a radical nephrectomy also involves the removal of the adrenal gland and sometimes the lymph nodes.
A laparoscopic nephrectomy is performed under a general anaesthetic. Three or four small abdominal incisions are made in the abdomen to provide access for surgical instruments that are used to detach the kidney and to ligate the blood vessels. The intact kidney is enclosed in a bag and removed through an incision or it may be placed in an impermeable sack, morcellated and removed through one of the port sites.
Hand-assisted laparoscopic nephrectomy allows the surgeon to place one hand in the abdomen while maintaining the pneumoperitoneum required for laparoscopy. A small incision is made which is just large enough for the surgeon’s hand and an airtight ‘sleeve’ device is used to form a seal around the incision. At the end of the procedure, the intact kidney can be removed through the same incision.
M02.- Total excision of kidney
Y75.2 Laparoscopic approach to abdominal cavity NEC orY75.4 Hand assisted minimal access approach to abdominal cavity
Note: A fourth character must be selected from category M02.- Total excision of kidney to further specify the nephrectomy or nephroureterectomy.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.