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Definition of Nephrectomy
Nephrectomy – a surgical OPERATION to remove a kidney.
The most common reasons for nephrectomy are to treat RENAL CANCER, to remove a kidney for live donor KIDNEY TRANSPLANTATION, and to remove a kidney that is severely injured due to trauma or malformed due to CONGENITAL ANOMALY.
There are three kinds of nephrectomy:
- partial nephrectomy, in which the surgeon removes only a portion of the kidney
- simple nephrectomy, in which the surgeon removes the entire kidney though leaves the surrounding tissue intact
- radical nephrectomy, in which the surgeon removes the kidney, surrounding tissues, and adjacent lymph nodes
Nephrectomy may be an open surgery, in which the surgeon operates through a large incision in the flank (side of the back), or laparoscopic, in which the surgeon operates through multiple small incisions using a laparoscope.
Nephrectomy takes place in a hospital operating room with the person under general ANESTHESIA. For open nephrectomy, the surgeon makes a large incision into the flank over the kidney. The incision gives access to the kidney without the need to penetrate the peritoneum, as the KIDNEYS lie behind this protective membrane.
The surgeon sutures off the renal ARTERY and VEIN and the URETER, then carefully cuts the kidney away from the adipose tissue that surrounds it and holds it in place. When the operation is radical nephrectomy for renal cancer, the surgeon also removes the adipose tissue, nearby connective tissue, and adjacent lymph nodes. After removing the kidney the surgeon sutures closed the incision, which will heal into a SCAR. Open nephrectomy takes two to four hours.
For laparoscopic nephrectomy, also called minimally invasive nephrectomy, the surgeon makes four or five small incisions, called ports, in locations around the flank on the side where the kidney will be removed. The surgeon inserts the laparoscope through one of the ports, and uses another to inflate the interior of the abdomen with a gas.
The surgeon inserts instruments through the remaining ports. The laparoscope has a light and camera on the tip that conveys the image of the interior abdomen to a closed-circuit television monitor. The surgeon operates by watching the monitor. When the kidney is free from its BLOOD supply and connecting tissues, the surgeon inserts a special bag through one of the ports and puts the kidney into it.
The surgeon carefully delivers the bag through the port, enlarging the port if necessary. When the kidney is out, the surgeon removes the instruments and laparoscope from their ports and sutures them closed. The ports heal into small scars. Laparoscopic nephrectomy takes three to five hours.
After either type of surgery, the person remains in the recovery room until fully awakened from the anesthesia and then goes to a hospital room. The hospital stay for open nephrectomy is generally five to seven days and for laparoscopic nephrectomy is generally three to five days. A person who undergoes open nephrectomy typically returns to regular activities in 8 to 12 weeks. A person who undergoes laparoscopic nephrectomy typically returns to regular activities in five to six weeks.
Risks and Complications
The primary risks of nephrectomy are bleeding and INFECTION, along with the potential for complications arising from anesthesia. These are uncommon events. The doctor will prescribe ANALGESIC MEDICATIONS to relieve postoperative PAIN. Further risks depend on the reasons for the nephrectomy. Some people experience fluctuations in BLOOD PRESSURE during the first few days after the nephrectomy, as the kidneys are key to regulating blood pressure in the body. This nearly always stabilizes without the need for treatment.
Outlook and Lifestyle Modifications
Most people fully recover and return to their regular activities after nephrectomy. The remaining kidney, if healthy, can more than adequately sustain the body’s needs. People who have renal cancer often undergo follow-up CHEMOTHERAPY or RADIATION THERAPY after surgery. The doctor may recommend dietary changes and other lifestyle modifications, depending on the person’s general health status.
A single kidney provides more than adequate function for people who are otherwise in reasonably good health. Lifestyle factors such as nutritious EATING HABITS, daily physical exercise, and maintaining healthy weight reduce strain on the kidney as well as the risk for HYPERTENSION(high blood pressure) and DIABETES, the two health conditions that are most likely to cause kidney disease.