A nephrectomy is a surgical procedure to remove part (partial) or all (total) of a kidney. Depending on the reason it is performed, a nephrectomy involves removing only the damaged portion of a kidney (a partial nephrectomy); all of one kidney (simple nephrectomy) or removal of kidneyalong with the surrounding adrenal gland and lymph nodes (radical nephrectomy). All types of nephrectomies are performed under general anesthesia. There are various reasons why a nephrectomy is performed.
The kidneys are located at the back of the abdomen above the pelvis. They are protected by the lower ribs. The function of the kidneys is to filter blood, which passes through them several times a day. The kidneys remove waste products, control fluid balance in the body, and regulate the balance of electrolytes in the body. As the kidneys filter blood, they create urine which is excreted during urination. Because there are two kidneys, and each kidney cell (nephron) is a microscopic filter on its own, a patient can function well after a partial or complete nephrectomy.
Reasons for Nephrectomy
A nephrectomy may be necessary to treat the following conditions:
● Congenital defect
● Nonfunctioning kidney
● Kidney damage (from kidney stones or disease)
● Kidney cancer
● Traumatic injury
● Kidney donation
Types of Nephrectomy
A partial nephrectomy is a removal of a small portion of the kidney. It targets the abnormal or diseased portion while maintaining the rest of the kidney tissue. It is frequently performed to treat kidney cancer or to remove worrisome lesions.
A simple nephrectomy involves the removal of an entire kidney. It may be performed to remove a diseased or severely injured kidney, or to remove a kidney for donation. It may be performed robotically or through an open incision
With a radical nephrectomy, the entire kidney, the surrounding lymph nodes, and the adjacent adrenal gland are removed. It may be performed when malignant tissue has spread from the kidney to surrounding tissue. It is generally performed through open incision.
Types of Nephrectomy Procedure
An open nephrectomy, which is the traditional procedure, involves making a moderate sized incision in the patient's abdomen or side. It provides greater access to the kidneys, as well as other surrounding organs. This is used for more complicated cases.
A robotic nephrectomy, which is less invasive, requires several poke hole sized small incisions. It is performed using a tiny camera and small instruments. It has many advantages over traditional open surgery including less bleeding, scarring and pain, and a shorter recovery time. Sometimes a procedure may be planned as robotic and need to be converted to an open procedure.
Risks of Nephrectomy
Every surgical procedure has risks, including excessive bleeding, adverse reactions to anesthesia or medications, post-surgical infection and damage to adjacent organs. Risks specific to nephrectomy include malfunction or failure in the remaining kidney, and hernia of the surgical wound.
Recovery from Nephrectomy
Depending on the type of nephrectomy and the difficulty of the procedure, generally a patient stays in the hospital for 1-5 days after the surgery. Recovery may take from 4-6 weeks depending on the type of nephrectomy and overall health of the patient. Strenuous physical activity may be restricted for a longer period. During the post-surgical hospital stay, a patient can expect the following:
• Urinary catheterization for 1-2 days post surgery
• Surgical drain at incision site
• Inability to eat for a few days and then slowly transitioning to a diet slowly
• Pain in abdomen and around surgical site
• Shoulder and upper abdominal pain if had robotic procedure
• To perform breathing exercises and to walk several times a day
• To need to use pillow to support abdomen
• Bowels to be slow to start working again
• To wear special stockings and/or take medications to prevent blood clots