Nephrectomy

Overview

A nephrectomy is a surgical procedure in which a kidney is removed. Your surgeon may choose to remove just a portion of your kidney during a partial nephrectomy or your entire kidney during a radical nephrectomy. A nephrectomy may save your life if you have cancer or kidney disease.

There are several ways for surgeons to access the kidney. A single incision on the side or in the stomach region can be used, known as an open nephrectomy. More commonly, the procedure is carried out by making several tiny incisions in the stomach region in which it is referred to as a laparoscopic nephrectomy.

Types

Nephrectomy procedures come in two different types:

• Partial nephrectomy: A surgical procedure in which a surgeon removes only the diseased or affected part of the kidney. You could undergo a laparoscopic/robotic partial nephrectomy or an open partial nephrectomy.
• Radical nephrectomy: where the kidney is completely removed by a surgeon. In a process known as a nephroureterectomy, surgeons can also remove a portion of the ureter. The adrenal glands, which are hormone glands located above the kidneys, may also be removed. This treatment can also be conducted using an open approach or through laparoscopic/robotic methods.

Reasons for undergoing the procedure

The primary reason of a nephrectomy is the removal of a kidney tumor. A kidney tumor could be benign (noncancerous) or malignant.

Nephrectomy may be used in different situations to treat a damaged or diseased kidney. When the kidney is the cause of recurring infections or ceases to function, some individuals require a nephrectomy. It is also used to remove a functioning kidney from an organ donor and transplant it into a recipient.

Risk

The level of risk associated with a procedure depends on several factors including the type of procedure, its purpose, your overall health, and various other considerations. Additionally, the expertise and skill of the surgeon play a crucial role in mitigating potential risks.

Surgery such as a nephrectomy is frequently safe. However, it has risks much as any operation, like:

• Reactions to anesthesia.
• Infection.
• Bleeding.
• Damage to surrounding organs.
• Pneumonia after surgery.
• Rarely, further severe issues including kidney failure.

Long-term complications of nephrectomy can arise from having fewer than two fully functioning kidneys. These issues may include hypertension, increased protein levels in the urine indicating kidney damage, and the development of chronic kidney disease.

For some individuals, undergoing a nephrectomy can lead to enduring complications, particularly concerning reduced kidney function. However, it’s worth noting that a single healthy kidney can effectively perform the work of two kidneys. If you’re contemplating kidney donation, it’s important to understand that most kidney donors go on to lead long and healthy lives post-nephrectomy.

Procedure

Two techniques are utilized by surgeons in nephrectomy procedures.

• Laparoscopic nephrectomy: A laparoscope, a tiny instrument with a camera, and a few tiny incisions are used during a laparoscopic nephrectomy. In a robotic-assisted laparoscopic procedure, the surgeon uses control of a surgical robot to move these tiny instruments.
• Open nephrectomy: One major incision is used during an open nephrectomy. Instead than using a camera, surgeons see straight within the body.

Shorter recovery times and reduced hospital stays can often be achieved with a laparoscopic nephrectomy. However, in cases where laparoscopic surgery isn’t feasible, healthcare providers may resort to open surgery. For instance, laparoscopic procedures typically require longer anesthesia durations, which may not be suitable for some individuals. Additionally, minimally invasive techniques may not be the most suitable choice for individuals with large kidney tumors, where an open approach could be safer in certain circumstances.

Before the procedure

Your healthcare provider will provide you with preparation instructions prior to kidney surgery. Some medications, like blood thinners, must be stopped in the days leading up to the procedure. In addition, your surgeon likely will advise you to refrain from eating and drinking the night before the surgery.

Blood will be drawn by your healthcare provider a few days prior to surgery. This test will identify your blood type in the event that you require a blood transfusion, baseline kidney function, and blood counts.

It is possible that you will need to spend one night, one week, or longer in the hospital. Depending on the kind of nephrectomy you have. How long it might take you recover is something you can ask your surgeon and the healthcare team.

During the procedure

Open or laparoscopic surgery may be performed by your surgeon. To guarantee you don’t feel anything, you will be given general anesthesia (medicine to help you stay unconscious) before to either kidney removal procedure.

• Laparoscopic nephrectomy:
  • Creates one or a few small incisions in the abdomen or side.
  • Inserts a laparoscopeinto the incision.
  • Uses a large display to view the laparoscope’s camera image.
  • Removes the damaged kidney or the complete kidney using the camera image and tiny surgical instruments.
  • Uses small, naturally dissolving stitches to close all incisions.
• Open nephrectomy
  • Makes a single abdominal incision.
  • Removes your entire kidney or just a diseased part within it.
  • Uses stitches to close the incision.

After the procedure

The type of nephrectomy that you receive and your general health will determine how long you spend in the hospital and how long you recover.

Your blood pressure, fluid levels, and electrolytes will all be observed by your healthcare team. Usually, a urinary catheter, which is a hollow tube for draining urine, is required for the initial days following surgery.

The incision will hurt at first, and you can experience some numbness as well. If necessary, your healthcare provider can assist you in managing your pain.

Deep breathing could be difficult because of the incision that will be made close to the diaphragm, the muscle that lies beneath your lungs. Engaging in diaphragmatic breathing exercises are essential for avoiding lung infections (pneumonia).

You should anticipate receiving instructions regarding dietary and activity restrictions before you leave the hospital. The healthcare team may advise you to begin performing simple, daily tasks as soon as you are comfortable doing so. However, as directed by your surgeon, you will need to avoid heavy lifting and intense activities for at least six weeks.

Outcome

After undergoing a nephrectomy, individuals with only one kidney need ongoing monitoring of kidney function. Six weeks post-surgery, blood tests will be required to assess the functioning of your remaining kidney. Your healthcare provider will provide guidance on the frequency of these tests. This typically involves blood tests and urinalysis.

Light activities may be resumed within a week or two after returning home, but heavy lifting and vigorous exercise should be avoided for at least six weeks. It’s essential to avoid activities that could potentially harm the remaining kidney, such as high-contact sports like football, hockey, and wrestling.

In cases of kidney cancer, a nephrectomy can be a life-saving treatment. Your donated kidney could save someone’s life. Most people adapt well to living with just one kidney.

Seek immediate medical attention if you experience any symptoms of kidney failure. If you see any of the following, call your healthcare provider:

• High blood pressure.
• Nausea and vomiting.
• Brain fog.
• Changes in the amount or frequency of urine, as well as changes in color.
• Edema of both face, legs, and lower back.