What you need to know about:

Nephrectomy

Fast Fact

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Average Cost:

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Recovery Period:

1-7 days in hospital

Permanence:

Depends on patient condition

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Doctors

Time it takes:

2-4 hours

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Anesthetize:

General Anesthesia

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Overview of

Nephrectomy

in Thailand

Nephrectomy is a surgical procedure that involves removal of a kidney from a patient. The procedure is performed in order to treat kidney cancer as well as other kidney diseases and injuries. Nephrectomy is also done to remove a healthy kidney from a donor (either living or deceased) for transplantation. 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). In some cases, these laparoscopic procedures are performed using a robotic system. In robotic surgery, the surgeon sits at a computer console near the operating table. He or she controls the camera arm and mechanical arms, which have surgical instruments attached to them that are working inside the patient's body. There are several types of nephrectomies that can be performed: 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.

Goals of

Nephrectomy

Most often a nephrectomy is 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. In the case of a donor nephrectomy, the urologic surgeon removes a healthy kidney from a donor for transplant into a person who needs a functioning kidney.

Price of

Nephrectomy

Average Cost

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Pros and cons of

Nephrectomy

Pros

-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.

Cons

-The patient will be left with only one kidney. As a result, drastic lifestyle changes must be made. A nephrectomy is usually the last line in treating patients with kidney cancer so you doctor will consider all other options before suggesting this approach.

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How it works:

Nephrectomy

This surgery is done in the hospital while you are asleep and pain-free (general anesthesia). The procedure depends on which type of surgey you will have: 1. Simple nephrectomy or open kidney removal: You will be lying on your side. Your surgeon will make an incision (cut) up to 12 inches or 30 centimeters (cm) long. This cut will be on your side, just below the ribs or right over the lowest ribs. Muscle, fat, and tissue are cut and moved. Your surgeon may need to remove a rib to do the procedure. The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed. Sometimes, just a part of the kidney may be removed (partial nephrectomy). The cut is then closed with stitches or staples. 2. Radical nephrectomy or open kidney removal: Your surgeon will make a cut about 8 to 12 inches (20 to 30 cm) long. This cut will be on the front of your belly, just below your ribs. It may also be done through your side. Muscle, fat, and tissue are cut and moved. The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed. Your surgeon will also take out the surrounding fat, and sometimes the adrenal gland and some lymph nodes. The cut is then closed with stitches or staples. 3. Laparoscopic kidney removal: Your surgeon will make 3 or 4 small cuts, most often no more than 1 inch (2.5 cm) each, in your belly and side. The surgeon will use tiny probes and a camera to do the surgery. Towards the end of the procedure, your surgeon will make one of the cuts larger (about 4 inches or 10 cm) to take out the kidney. The surgeon will cut the ureter, place a bag around the kidney, and pull it through the larger cut. This surgery may take longer than an open kidney removal. However, most people recover faster and feel less pain after this type of surgery when compared to the pain and recovery period following open surgery.

Preparation before

Nephrectomy

Pre - treatment

A number of tests will be carried out to make sure that your heart, lungs and kidneys are working properly. You may have a chest x-ray, or electrocardiogram (ECG, which records the electrical activity of your heart) and some blood tests. Your doctor will explain any other tests you need. If you do not attend, we may have to cancel your surgery. If you smoke, you may be asked to stop smoking. Smoking increases the risk of developing a chest infection or DVT. Smoking can also delay wound healing because it reduces the amount of oxygen that reaches the tissues in your body. You will also discuss with your doctor abot any any regular medicines that you take, including anything you buy over the counter or any herbal or homeopathic medicines, and if you have any allergies to any medicines. If you are taking any medicines, these may need to be temporarily stopped or adjusted around the time of your surgery or treatment, you will be given information on how to do this at your pre-assessment appointment. Do not make any changes to your usual medicines and continue to take them unless you have been advised to do so. If you are taking any medicines that thin your blood, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for examples warfarin or rivaroxaban), please tell your doctor or nurse as you may need to stop them temporarily before your surgery. Also tell your doctor or nurse if you have diabetes as you may need to alter the dose of your diabetes medicines, as you will need to fast before the procedure. Further information on stopping any medicines will be given to you when you come for preassessment. You will also be expected to ahdhere to a healthy normal diet in the weeks running up to your operation. It is also a good idea to take some exercise, as this can prepare your heart and lungs for the challenges of the operation.

Recovery after

Nephrectomy

Post - treatment

Immediately after surgery, your health care team will carefully watch your blood pressure, electrolytes and fluid balance. These body functions are controlled in part by the kidneys. You will most likely have a urinary catheter (tube to drain urine) in your bladder for a short time during your recovery. You may have discomfort and numbness (caused by severed nerves) near the incision area. Pain relievers are given after the surgical procedure and during the recovery period as needed. Although deep breathing and coughing may be painful because the incision is close to the diaphragm, breathing exercises are important to prevent pneumonia. You will probably remain in the hospital for 1 to 7 days, depending on the method of surgery used. You will be encouraged to return to light activities as soon as you feel up to it. Strenuous activity and heavy lifting should be avoided for 6 weeks following the procedure. Your doctor will give you more detailed instructions about your post-operative activities, restrictions and diet.

Risks & side effects

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. Infection. Decrease in efficiency of the remaining kidney immediately after the procedure. Injury to the nerves close to the incisions. Hernia at the incisions.

FAQs:

Nephrectomy

What are the recommendations for travel for this procedure?

After the procedure, your doctor will assess your condition and incision before making recommendations for travel. You will be given instructions for caring for yourself and your incision if your doctor considers that it is safe for you to travel.

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Once I have one of my kidneys removed, how should I care for my remaining kidney?

You will be undergoing regular testing to check how well the remaining kidney is working. A urinalysis (urine test) and blood pressure check should be done every year, and kidney function tests (creatinine, glomerular filtration rate [GFR]) should be checked every few years (or more often if abnormal results are found). Regular urine tests for protein should be performed as well. The presence of protein in the urine may mean that the kidney has some damage. People with one kidney should also avoid sports that involve higher risks of heavy contact or collision. This includes, but is not limited to, boxing, field hockey, football, ice hockey, lacrosse, martial arts, rodeo, soccer and wrestling. This may also include extreme activities such as skydiving. Anyone with a single kidney who decides to participate in these sports should be extra careful and wear protective padding. He or she should understand that losing the remaining kidney is a very serious situation.

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