Treatment / Nephrectomy

Removal of the Kidney
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Overview: Nephrectomy Procedures

A nephrectomy is a surgical procedure where all or part of a kidney is removed. This procedure can be performed for various reasons, including to treat kidney cancer, remove a damaged or non-functioning kidney, or for a kidney donation. Depending on the extent and purpose of the removal and the approach utilized, nephrectomies can be categorized into simple or radical. There are also different methods, including open, laparoscopic, and robotic approaches.

1. Simple Nephrectomy:

  • Definition: This procedure involves removing only the kidney. Surrounding structures like the adrenal gland and surrounding fat are typically left intact.
  • Indications: Non-cancerous kidney diseases, chronic infections, or severely damaged kidneys.

2. Radical Nephrectomy:

  • Definition: In a radical nephrectomy, the entire kidney, a portion of the ureter, the adrenal gland, and surrounding fatty tissue are removed.
  • Indications: Often recommended for treating kidney cancer, especially if the tumour is large or involves major portions of the kidney.

3. Partial Nephrectomy:

A partial nephrectomy, often referred to as “kidney-sparing” or “nephron-sparing” surgery, is a procedure where only the diseased or injured portion of the kidney is removed, leaving behind the healthy part to continue its function. This approach aims to preserve as much of the kidney’s functionality as possible, making it particularly beneficial for patients with conditions in only one part of the kidney or those who have a solitary kidney. By retaining kidney tissue, patients are at a reduced risk of chronic kidney disease post-surgery. Like full nephrectomies, partial nephrectomies can be performed using open, laparoscopic, or robotic-assisted techniques, depending on the tumor’s size, location, and complexity, as well as the surgeon’s expertise.

Approaches to Nephrectomy:

A. Open Nephrectomy: This is the traditional method where a large incision is made, either in the front or side of the abdomen, to access the kidney.

  • Advantages: Direct access, sometimes preferred for larger tumours or complicated cases.
  • Disadvantages: Larger scar, potentially longer hospital stay, and recovery time.

B. Laparoscopic Nephrectomy: Small incisions are made in the abdomen in this method. A laparoscope, a thin tube with a camera on the end, is inserted to guide the surgeon during the procedure.

  • Advantages: Smaller incisions, less pain, shorter hospital stay, and quicker recovery.
  • Disadvantages: Technically challenging and unsuitable for all patients or tumours.

C. Robotic-Assisted Laparoscopic Nephrectomy: A robotically-assisted surgical system performs the nephrectomy. The surgeon controls the robot, translating the surgeon’s hand movements into smaller, more precise movements of tiny instruments inside the body.

  • Advantages: Enhanced precision, flexibility, and control compared to traditional methods. Small incisions lead to less pain and quicker recovery.
  • Disadvantages: Requires specialized equipment and training. Not available at all hospitals.

The type of nephrectomy and approach taken depends on the reason for surgery, the size and location of any tumours, and the overall health and anatomy of the patient. Each method has its benefits and risks, and the choice of approach will be determined in consultation with a urologist or surgeon specialized in renal procedures. When considering a nephrectomy, always discuss the potential risks and benefits with your healthcare provider.

Postoperative Recovery:

  1. Hospital Stay:
    • Open Nephrectomy: Patients typically stay in the hospital for several days.
    • Laparoscopic or Robotic-Assisted Nephrectomy: The stay is generally shorter, often 1-3 days, depending on the individual’s recovery pace.
  2. Activity:
    • Patients are encouraged to engage in light activities, such as walking, as soon as possible. This helps prevent complications like blood clots.
    • Heavy lifting and vigorous activities are restricted for several weeks.
  3. Pain Management:
    • Pain at the incision site(s) is common. Pain medications, both prescription and over-the-counter, are provided to manage it.
  4. Follow-up Appointments:
    • Regular follow-up visits with the surgeon are essential to monitor recovery and address any complications.
  5. Diet:
    • Initially, patients might be on a liquid diet, transitioning to solid foods as tolerated.
    • Hydration is crucial to help the remaining kidney function effectively.
  6. Wound Care:
    • Keeping the surgical site clean and dry is essential.
    • Any signs of infection, like increased redness, swelling, or discharge, should be reported immediately.

Potential Postoperative Issues:

  1. Infection: Signs include fever, redness, swelling, or discharge from the incision site.
  2. Bleeding: Some bleeding is typical after surgery, but excessive bleeding can lead to complications.
  3. Blood clots: Immobility can increase the risk of blood clots in the legs, which could travel to the lungs and become life-threatening.
  4. Lung Issues: Some patients might develop pneumonia or have difficulty breathing after surgery.
  5. Chronic Pain: Some patients might experience persistent pain at the surgical site.
  6. Kidney Function: The remaining kidney typically takes over the function of the removed kidney. However, there’s a possibility of reduced kidney function, which would require monitoring and potential treatment.
  7. Hernia: A potential complication of any abdominal surgery is the development of a hernia at the incision site.
  8. Reactions to anaesthesia: As with any surgery that requires anaesthesia, there’s a risk of adverse reactions.
  9. Scar tissue: Over time, scar tissue might develop internally, potentially causing pain or obstructing the intestines.

Tips for Enhanced Recovery:

  1. Follow medical advice: Adhering to the surgeon’s and medical team’s recommendations is crucial for a smooth recovery.
  2. Stay active: Gentle walking can aid circulation and recovery.
  3. Monitor symptoms: Any signs of complications should be reported promptly.
  4. Stay hydrated and maintain a balanced diet: This supports healing and the remaining kidney’s function.

As always, individual experiences can vary. Maintaining open communication with the healthcare team is essential to address any concerns or complications promptly.


Further Reading and Leaflets

  1. British Association of Urological Surgeons Leaflet on Laparoscopic Radical Nephrectomy
  2. British Association of Urological Surgeons Leaflet on Open Radical Nephrectomy
  3. British Association of Urological Surgeons Leaflet on Laparoscopic Simple Nephrectomy
  4. British Association of Urological Surgeons Leaflet on Open Partial Nephrectomy
  5. British Association of Urological Surgeons Leaflet on Robotic Partial Nephrectomy