Robotic Kidney Surgery (Nephrectomy)

Understanding the operation

Using the da Vinci Xi surgical system, our surgeons perform the full range of robotic kidney, adrenal, and upper-urinary-tract operations — with more precision, less pain, and faster recovery than open surgery. Depending on your condition, yours may be:

• Partial nephrectomy — removing a kidney tumor while preserving the healthy kidney ("nephron-sparing"), the ideal option for suitable tumors, typically under 4 cm. Occasionally operative findings require removing the whole kidney, or converting to open surgery.
• Radical nephrectomy — removing the entire kidney and surrounding fat, sometimes with the adrenal gland or nearby lymph nodes, with high-definition control of the kidney's major blood vessels.
• Simple nephrectomy / nephroureterectomy — removing a kidney (and its ureter) for benign conditions.
• Radical nephroureterectomy with bladder-cuff excision — for urothelial cancers of the upper tract; removes kidney, ureter, and the small patch of bladder where the ureter enters, repaired with stitches.
• Pyeloplasty — reconstructing a blockage where the ureter joins the kidney (UPJ obstruction); a ureteral stent is placed and removed in the office about 4–6 weeks later.
• Upper-tract reconstruction and robotic stone surgery (pyelolithotomy) — for strictures and stones beyond endoscopic reach.

Before surgery: your work-up

Depending on your other health conditions, a consultation with a cardiologist or another physician may be needed to make sure you're healthy enough for the operation. The pre-operative evaluation includes a history, physical exam, blood tests, and a urine sample — and may add a chest X-ray, EKG, or further imaging as needed. You may also meet with an anesthesiologist and/or your primary care physician before surgery; follow their advice carefully.

Before surgery: medications

• Blood thinners must be stopped before surgery, always in coordination with your prescribing physician: aspirin, Aggrenox, ibuprofen, naproxen, Indocin, or Bufferin — 7 days before; Plavix — typically 5–7 days before; Coumadin, Xarelto, Eliquis, Pradaxa, heparin, or Lovenox — typically at least 3–5 days before, as your prescriber recommends.
• Avoid dietary supplements and over-the-counter medications for 2 weeks before surgery — they can cause bleeding or unexpected reactions.
• Make sure we know every medication and supplement you take at home.

The day before surgery

• Eat only light meals, with only clear liquids after breakfast. Clear liquids are anything you can see through: water, apple juice, Jell-O without fruit, black coffee, tea, soda. Milk, creamer, dairy, orange or grapefruit juice, and juices with pulp are NOT clear.
• Take two tablets of Dulcolax (bisacodyl) in the afternoon the day before surgery, to clear your bowels. (If you have constipation problems, follow your primary care physician's or gastroenterologist's guidance instead.)
• Nothing to eat or drink after midnight. Cape Cod Hospital calls you the day before to go over final diet instructions — follow them carefully.
• Take your morning-of-surgery medications only as instructed by your surgeon, anesthesiologist, primary care physician, or the hospital staff.
• Bring a relative or friend to assist you on the day of surgery.
• Deep breathing, meditation, or gentle exercise help you arrive relaxed — and if you're overweight, even modest weight loss before surgery can make the operation easier and improve results.

In the hospital

• Walking is critically important — in most cases you'll be up and walking the same day as surgery. The goal is about 2–3 hours of hallway walking per day while awake: it wakes up your bowels, protects your lungs, improves circulation, and prevents blood clots.
• You'll get an incentive spirometer — a plastic breathing device to expand your lungs. Use it about 10 times per hour while awake.
• Compression sleeves (SCDs) on your lower legs inflate and deflate to keep blood moving; simple foot-pump exercises (point your toes down, then up toward your face, repeat often) add to the protection.
• You may have a small abdominal drain after surgery; it's typically removed in your hospital room before discharge — briefly uncomfortable, not significantly painful.
• Pain is managed with a combination of medications — many patients never need opioids after robotic surgery.
• Diet starts with liquids right after surgery; if you're progressing, regular food typically resumes the next morning.

Your catheter & drain

• You'll wake with a urinary catheter; in most kidney operations it comes out the day after surgery. Some procedures need it longer, and some patients go home with it — your individual plan is communicated around the time of surgery.
• A small abdominal drain, if placed, is typically removed in your room before discharge.

Eating, drinking & your bowels at home

• Start with small, frequent meals and build back to three meals a day — your appetite will be lower than usual, and that's fine.
• Avoiding constipation is a priority: straining puts pressure on the surgical sites and raises hernia risk. Stay hydrated, add roughage, and use the stool softener we prescribe (docusate/Colace); MiraLAX is a safe over-the-counter addition as needed.
• Drink 8–10 glasses of water or fluid daily (unless you have a fluid restriction).
• Avoid carbonated drinks for the first few days.
• If you notice blood in your urine, increase fluids to dilute it.

Activity rules

• Walk — short, frequent walks, gradually longer each day. Rest on purpose between them. Your own body is the best gauge.
• Don't sit in one place longer than 90–120 minutes.
• No lifting over 10 pounds (about a gallon of milk) for 4–6 weeks — this protects against hernia at the incisions. Avoid strenuous activity for at least 2–4 weeks.
• Brace a hand over your largest incision when coughing, straining, or during bowel movements.
• Absolutely no biking, motorcycling, or horseback riding for 4 weeks.
• Shower 48 hours after surgery — let soapy water run over the incisions, no scrubbing, pat dry. No tubs, swimming, or submerging the incisions for 4 weeks.
• No driving while a catheter is in place or while taking pain medication — and not until pain wouldn't stop you from braking suddenly.
• Bend at the knees, not the waist.
• Stairs are fine — take them slowly, use the rail.

Your incisions

• You'll have several small "port" incisions closed with absorbable sutures and skin glue (Dermabond) — the glue flakes off on its own. If staples were used instead, they're removed at your follow-up.
• Remove any gauze dressings within 48 hours after surgery.
• A small amount of drainage can happen. No lotions, creams, alcohol, or hydrogen peroxide on the incisions — they interfere with the protective glue. Don't scrub.
• Pus, foul-smelling drainage, or an incision that turns red and painful are infection signs — call the office immediately.

Recovery notes specific to kidney surgery

• After a partial nephrectomy especially, take the strenuous-activity restriction seriously for at least 2–4 weeks — the repaired kidney needs protecting while it heals.
• Your follow-up plan (including any stent removal and imaging schedule) is set by your surgeon and communicated at discharge.

Getting fit before surgery (it genuinely matters)

Major surgery has been compared to running a marathon — and the fitter you arrive, the fewer the complications and the faster the recovery. Between now and your surgery:

• Eat heart-healthy: lean protein (fish, poultry, beans, eggs), whole grains, fruits and vegetables; skip sugary and processed foods. Add a high-protein shake twice a day (Ensure High Protein, Fairlife Core Power, Boost High Protein, and similar).
• Hydrate — multiple 6–8 oz glasses of water daily. Limit alcohol to no more than 2 drinks a day, and none in the 24 hours before surgery.
• Move: work toward walking 3 miles a day (three 1-mile walks count), plus simple resistance exercises — squats, bridges, planks. Even a few weeks of this improves your recovery.
• If you smoke: stopping cuts your complication risk dramatically — smoking raises post-surgical complications by 40%. Within 72 hours of quitting, breathing already improves.