Nephrectomy is a surgical procedure that involves the removal of a part (partial nephrectomy) or whole (radical nephrectomy) of your kidney. Kidneys are bean-shaped organs located behind your abdominal organs, placed on each side of your spine. Nephrectomy is a surgery that helps treat tumors and other pathological diseases of the kidneys that impair their function and cause other life-threatening complications.
Partial or Total Nephrectomy can be performed through different methods, namely:
- Open nephrectomy- Traditional approach involving a single large incision (cut).
- Laparoscopic nephrectomy- A less invasive method that involves multiple small incisions.
- Robotic nephrectomy- A modern technique that uses robotic technology to assist surgeons.
This article will help you understand nephrectomy, the different surgical methods involved, its benefits, and the possible risks associated.
Kidneys are organs that help filter waste and excess fluids from your body, produce urine, maintain the levels of minerals in the bloodstream, and produce hormones to regulate blood pressure. When these organs are diseased or if there are any abnormal pathologies associated (such as kidney stones or tumors), the normal function of the kidneys is impaired. Nephrectomy is a life-saving surgical procedure involving removing one kidney (unilateral) or both kidneys (bilateral).
There are two types of nephrectomy procedures:
Partial Nephrectomy
- The procedure involves the removal of only the diseased portion of the kidney.
- The healthy part will be left behind.
Radical/ Total Nephrectomy
- In this procedure, your surgeon will remove the entire kidney.
- The surgery may also involve the removal of a part of the ureter (a tube-like part that opens into the bladder) in a procedure known as nephroureterectomy.
- Sometimes, your adrenal glands (small glands present above both your kidneys that produce hormones) may also be removed.
There are various reasons why your surgeon may recommend a nephrectomy. These include:
- Kidney tumors that may be benign (non-cancerous), or malignant (cancerous).
- Kidney failure, where the normal kidney is impaired and fails to perform its function.
- A congenitally small kidney (congenital dysplasia) where the person is born with a small kidney, with a recurrent urine infection, scarring of the kidney, and eventually kidney failure.
- Nephrectomy is performed on the donor (a living or a dead person whose kidney is used to transplant into a diseased person) for a kidney transplant.
For small kidney tumors, your surgeon may perform a partial nephrectomy and salvage some parts of the kidney; for larger tumors, a total nephrectomy will be done.
Nephrectomy is an inpatient (requires hospitalization) procedure performed under general anesthesia, which means you will be put to sleep during the entire surgery.
- On the day of the surgery, your vitals (blood pressure, heart rate, pulse, oxygen level, and urine output) will be checked.
- You will be taken to the operating theater, followed by GA administration through IV (intravenous) infusion.
- You will be placed in a supine position (lying flat on your back).
- Nephrectomy can be done as partial or total nephrectomy. Total Nephrectomy and Partial Nephrectomy can be done by open, laparoscopic, or robotic-assisted techniques.
Total Nephrectomy
Open
- This method involves a single large incision (cut) made in the abdomen or the flank area (the side of the abdomen) using a scalpel (surgical blade).
- The ureter and blood vessels are cut away, and the diseased kidney is removed, closing the incision with stitches.
- The surgery takes around 1 to 2 hours.
Laparoscopic
- The abdomen will be inflated with carbon dioxide gas
- Laparoscopic nephrectomy involves multiple keyhole-sized incisions made in the abdominal wall.
- A laparoscope (a tube-like device that consists of a light source and a camera that captures images and projects them on the screen that guides the surgeon to visualize the surgical site and perform the surgery) will be inserted into one of the cuts.
- Through the other incisions, surgical instruments will be passed, and the kidney is removed.
- The incisions are closed with small sutures (stitches) that dissolve on their own.
- The surgery takes around 2 to 3 hours.
Robot-assisted
- This is an advanced minimally invasive procedure that uses a robotic system to assist the surgeon.
- The surgeon makes multiple tiny incisions with a scalpel in the abdominal wall or the flank area.
- The surgeon will be seated at the robotic consort (a platform from where the robotic arm can be easily handled).
- The robotic arm assists the surgeon to removing the kidneys while inserting surgical instruments through the keyhole incisions.
- The incisions are stitched up with resorbable sutures.
- The procedure takes around 2 to 3 hours.
Partial Nephrectomy
Open
- Your surgeon will determine the exact location of the tumor.
- In this method, the surgeon will make a single large incision (12 inches) in your flank area (fleshy area between your hip and ribs), using a scalpel (surgical blade).
- A clamp will be used to block the blood vessels.
- Crushed ice will be used to lower the kidney temperature as this helps prevent tissue breakdown from the lack of blood flow.
- The tumor is located and removed in total.
- The wound is closed with stitches, and medications will be applied to prevent bleeding.
- The surgery takes around 3 to 4 hours.
Laparoscopic
- The abdomen is inflated with carbon dioxide gas.
- Laparoscopic nephrectomy involves multiple keyhole-sized incisions made in the abdominal wall.
- A laparoscope (a tube-like device that consists of a light source and a camera that captures images and projects them on the screen that guides the surgeon to visualize the surgical site and perform the surgery) will be inserted into one of the cuts and other surgical instruments through other incisions.
- The blood flow to the kidney will be stopped, and the tumor will be removed / condition corrected.
- The kidney will be reconstructed, and the incisions closed with small sutures (stitches) that dissolve on their own.
- Small drain is placed at the incision site to drain out the fluid for a few days.
- Advantage of this minimally invasive procedure is that there is a lower risk of kidney failure developing in the future, improved aesthesis, decreased pain, and less blood loss, leading to fewer days in the hospital.
- The surgery takes around 3 to 4 hours.
Robot-assisted
- This is an advanced minimally invasive procedure that uses a robotic system to assist the surgeon.
- The surgeon makes multiple tiny incisions with a scalpel in the abdominal wall or the flank area.
- The surgeon will be seated at the robotic consort (a platform from where the robotic arm can be easily handled).
- The robotic arm assists the surgeon in dissecting and exposing the diseased kidney.
- The tumor is located with the ultrasound probe, and the blood supply to the kidney is temporarily stopped by clamping the blood vessels.
- The tumor, surrounding fat and lymph nodes, and the rim of the healthy kidney is removed through one of the openings in the abdomen. The tissue is later sent to the laboratory to check for malignancy.
- Small drain is left at the incision site to drain out the fluid for a few days.
- The incisions are stitched up with resorbable sutures.
- The procedure takes around 3 to 4 hours.
You are expected to stay in the recovery room for an hour or two until you regain consciousness while your vitals are monitored.
In The Hospital:
- Once stabilized, you will be shifted to your ward since you require 1 to 7 days of hospitalization depending on the severity of the condition and the type of surgical method performed.
- There will be a urinary catheter (a tube to drain urine) placed for the initial few days during recovery.
- You are expected to feel mild pain and discomfort, which will be managed through painkillers post-surgery and during recovery.
- Your medical team will closely monitor your kidney function, blood pressure, and fluid balance.
- You will not be allowed to eat for the first 2 days after the surgery and will gradually progress to a liquid diet.
At Home:
- You are expected to take care of your wound and keep it clean and dry.
- You are advised not to indulge in strenuous physical activities and exercises for a period of 6 weeks post-nephrectomy.
- You must follow breathing exercises to prevent pneumonia (lung infection), which will be instructed before you leave the hospital.
- You must continue taking antibiotics and painkillers until advised by your doctor.
- Recovery may take around 6 to 8 weeks, depending on the surgical approach followed.
Nephrectomy is a procedure that helps relieve symptoms like pain and discomfort. Some of the key benefits are discussed below:
Benefits:
- Enhanced patient survival- This is especially the case in partial nephrectomy, where your quality of life is enhanced by improving your chances of survival.
- Relief from symptoms- Associated kidney failure symptoms like severe abdominal pain, frequent infections, weight loss, etc is alleviated.
- Complete removal of cancer- Nephrectomy (especially radical) can help prevent the further spread of cancer by removing the kidney tumor, and preventing future recurrence.
- Improved kidney function- The remaining kidney can compensate for the loss of the removed kidney.
Risks:
Though nephrectomy is beneficial in the long run, as with any surgical procedure, nephrectomy too has some risks involved:
- Excessive bleeding during surgery may require a blood transfusion.
- Post-operative pain and discomfort that require pain management.
- Risk infection at the surgical site causing fever, body aches, and chills.
- There may be numbness and tingling sensation near the surgical site due to nerve damage.
- Difficulty urinating and may require a catheter (a tube with a urine bag) temporarily.
- Risk of clot formation that would dislodge and travel through the bloodstream to other organs like lungs (pulmonary embolism).
- Sometimes the remaining kidney may fail to compensate for the lost kidney, eventually leading to renal (kidney) dysfunction and chronic (long-lasting) kidney disease.
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