A nephrectomy is the removal of all or part of a kidney. A nephrectomy is commonly performed to treat kidney cancer or to remove a noncancerous (benign) tumor. In some cases, a nephrectomy is performed to deal with a diseased or seriously damaged kidney. The urologic surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen using a camera and small instruments (laparoscopic nephrectomy).
There are several types of nephrectomies, they include:
-Partial nephrectomy is the removal of part of a kidney.
-Radical nephrectomy is the removal of a kidney, the adrenal gland, and the surrounding lymph nodes.
-Total nephrectomy is the removal of a kidney.
-Bilateral nephrectomy is the removal of both kidneys.
The most common reason a urologic surgeon performs a nephrectomy is to remove a tumor from the kidney. These tumors are usually cancerous, but they can be noncancerous (benign). Sometimes a nephrectomy is needed because of other kidney diseases.
Other situations that may warrant for a kidney removal include the following conditions:
· If the patient undergoes an accident that damages the kidney beyond repair.
· If the patient must undergo a kidney transplantation.
· If the patient’s kidney is destroyed due to infection, kidney stone, kidney cyst, or urinary tract obstruction.
· If the patient has a malignant tumor, a kidney as well as the adrenal gland and surrounding lymph nodes must be removed. In some cases just part of the kidney will be removed, depending on the location and size of the tumor.
· If the patient suffers from extremely high blood pressure due to narrowing of the blood vessels to the kidney, leading to kidney death.
-A nephrectomy offers a definitive treatment for removal of a any lesions that occurs in the kidney.
-The procedure comes with risks with it
A nephrectomy procedure is performed during general anesthesia. You'll receive a medication (anesthetic) before surgery so that you won't be awake or feel pain during surgery. You'll also have a urinary catheter — a small tube that drains urine from your bladder — placed before surgery. During the procedure, the urologic surgeon and anesthesia team work together to minimize pain after surgery.
The nephrectomy procedure varies, depending on how the surgery is performed and how much of the kidney is removed. Variations include:
-Laparoscopic surgery. In this minimally invasive procedure, the surgeon makes a few small incisions in your abdomen to insert wandlike devices equipped with video cameras and small surgical tools. The surgeon must make a slightly larger opening if your entire kidney needs to be removed.
-Open surgery. In an open nephrectomy, the urologic surgeon makes a cut (incision) along your side or on your abdomen. This open approach allows surgeons to perform some surgeries that still can't be performed safely with less invasive approaches.
-Radical nephrectomy. In a radical nephrectomy, the surgeon removes the whole kidney, the fatty tissues surrounding the kidney and a portion of the tube connecting the kidney to the bladder (ureter). The surgeon may remove the adrenal gland that sits atop the kidney if a tumor is close to or involves the adrenal gland. In some cases lymph nodes or other tissues are removed as well.
-Partial nephrectomy. In a partial nephrectomy — also called kidney-sparing (nephron-sparing) surgery — the surgeon removes a cancerous tumor or diseased tissue and leaves in as much healthy kidney tissue as possible.
-Robot-assisted laparoscopic surgery. In a variation of laparoscopic surgery, the surgeon uses a robotic system to perform the procedure. Robotic tools require very small incisions, provide better 3-D images during the procedure, and can make fine or complex motions that are similar to what a surgeon's hand can do in open surgery.
Before surgery, you'll talk with your urologic surgeon about what options are available for you.
You may need to stay in the hospital from one night to a week or more, depending on the type of procedure. Ask your surgeon and health care team about your probable recovery time. You'll receive instructions about what to do the day before and the day of your surgery.
Recovery time after the procedure and the length of your hospital stay depend on your overall health and the type of nephrectomy performed. The urinary catheter remains in place for a short time during your recovery.
Expect to receive instructions before leaving the hospital about restrictions to your diet and activities. You may be encouraged to begin light, everyday activities as soon as you feel able, but you'll need to avoid strenuous activity or heavy lifting for several weeks.
For most patients, these procedures don't affect quality of life — once you're completely recovered, you can expect to resume your normal routine and activities.
-Injury to nearby organs, such as the intestines, liver, spleen, and pancreas.
-Bleeding in the abdominal cavity or at the incisions.
-Leaking into the pleural cavity during the surgery, causing collapse of the lung.
-Decrease in efficiency of the lungs or respiratory system after the procedure.
-Decrease in efficiency of the remaining kidney immediately after the procedure.
-Injury to the nerves close to the incisions.
-Hernia at the incisions.
How do I take care of the remaining parts of the kidney(s)?
After a nephrectomy or partial nephrectomy, you may have overall normal kidney function. To preserve normal kidney function, your doctor may recommend that you eat a healthy diet, engage in daily physical activity and attend regular checkups to monitor your kidney health.
If you develop chronic kidney disease (reduced kidney function) after complete or partial nephrectomy, your doctor may recommend additional lifestyle changes, including possible dietary changes and being careful about prescription and over-the-counter medications.
How does the surgeon determine how much kidney is removed?
The decision about how much kidney tissue to remove depends on:
-Whether a tumor is confined to the kidney
-Whether there is more than one tumor
-How much of the kidney is affected
-Whether the cancer affects nearby tissue
-How well the other kidney functions
-Whether other diseases affect kidney function
-Overall kidney function
What is the advantage of laparoscopic radical nephrectomy as compared to open surgery?
Laparoscopic nephrectomy has been routinely performed since 1990 and has translated into significant benefits for patients including reduced blood loss and transfusions, reduced pain, shorter hospital stays, improved cosmesis, and a faster recovery as compared to open surgery. While open surgery requires either a large abdominal or flank incision, minimally invasive approaches involve 3-4 keyhole incisions in the abdomen.