Nephrectomy is simply “kidney removal” and can be performed for patients who need a neobladder reconstruction but have damaged kidneys. This procedure involves simple, partial, radical (similar to nephroureterectomy), and laparoscopic nephrectomy. The kidneys are two bean-shaped organs about the size of one’s first and located on the right and left side of the abdomen, just below the diaphragm. Their function is filtering food and liquid intake, removing excess minerals and liquid not needed by the body, and passing these waste products out in the form of urine.
When the kidney(s) are damaged, injured, cancerous, or there is a need for a kidney transplant or donation, surgery is carried out called “nephrectomy“.
What is Nephrectomy?
Nephrectomy is a surgical procedure used to remove all or parts of the kidney(s). It is simply called “kidney removal“.
Why Is Nephrectomy Done?
The surgical removal of all or parts of the kidney is done for the following reasons:
Types of Nephrectomy
The types of nephrectomy usually determine the type of procedure that would be carried out. They include:
- To treat a cancerous kidney.
- To remove kidney benign tumors.
- To treat diseased or damaged kidneys caused by severe trauma from accidents, infections, and diseases such as blocked urinary tract, hypertension, renal artery stenosis, etc.
- To remove kidney stones or cysts.
- For patients who need a neobladder reconstruction, but have damaged kidneys.
- To conduct a kidney transplant.
- To remove a non-functioning, or rejected donor’s kidney.
This type of kidney removal involves the removal of the parts of the kidney that are diseased or damaged.
This is the removal of one entire kidney.
- Partial Nephrectomy (Kidney-sparing)
This type involves the removal of an entire kidney along with the structures surrounding it, such as the ureter, the fat, the adrenal gland, and the lymph nodes. This process is similar to nephroureterectomy.
There can also be the removal of the whole of both kidneys at the same time, which is called “bilateral nephrectomy”.
The process which involves the removal of a healthy kidney(s) from a donor–either living or diseased–for transplantation is called “donor nephrectomy”.
Risk and Complications
Nephrectomy is a surgical procedure with a high success rate and is considered generally safe. But like all surgeries, some risks or complications are estimated to likely occur during the process, after the process, or in the long run.
The risks often depend on the type of nephrectomy and the procedural method or surgical approach of the nephrectomy. However, these complications are rare, but can include:
- Radical (Complete) Nephrectomy
Long term, there can be complications like:
- Hemorrhage or blood loss
- Allergic reactions to anesthesia or other medications used.
- Surrounding organs, nerves, and/or tissue injury.
- Puncture of the chest cavity.
- Pulmonary embolism; blood clots that form in your legs and move to your lungs which could cause a blockage of the track and lead to a stroke or heart attack.
- Hernia; lumpy bulge on the bowel that may arise from the scarring of the incision site.
Preparing for the Surgery,
Consult with your urologic surgeon, who will go through your medical history to see if you are fit for the surgery. Screening tests such as MRIs, X-rays, endoscopic tests, etc, will be carried out to see the state of your kidney and what type of nephrectomy will be needed.
Also, your surgeon may require you to choose the surgical approach that you are comfortable with. Although these approaches often depend on the type of kidney removal you will be having.
The procedural approach includes simple (open) nephrectomy procedure, radical nephrectomy procedure, and laparoscopic nephrectomy procedure.
You will be required to stay off some medications such as nonsteroidal anti-inflammatory drugs and blood-thinners, stop the intake of alcohol, quit smoking, 3 to 4 weeks before the surgery. Also, make sure to avoid eating at least 12 hours before the surgery to prevent nausea from the anesthesia.
During the Surgery,
A blood bag will be made ready in case of hemorrhage during the surgery. General anesthesia will be injected into you and an IV drip will be connected to you through an IV line. The surgical area will be cleaned with antiseptics to keep it from being infected.
As stated, the process follows 3 methods and they involve:
Simple (Open) Nephrectomy Procedure
This method is used for simple and partial types of nephrectomy.
- The decrease in kidney function if one kidney is left.
- Kidney diseases
- High blood pressure or hypertension.
(For partial nephrectomy, the diseased or damaged parts are cut away and the kidney is stitched back up.)
- You will be laid on your side on an angular operating table with your upper and lower body bent sharply away at your waist, stretching your side to give easy access to the kidney.
- An angular incision of about 8 to 10 inches long will be made on the side, just below your ribs or over the last 2 ribs, extending from your spine from the side to the front of your abdomen.
- If considered necessary, the last one or two ribs may be removed to perform the surgery.
- Surrounding organs, tissues, fat, muscles will be moved aside carefully to prevent injury when the kidney is operated on.
- The ureter and blood vessels of the kidney will be tied up and cut off.
- The kidney is removed.
Radical Nephrectomy Procedure
This is used mainly for the radical type of nephrectomy.
- The part of the ureter and blood vessels left in the body is stitched closed. Unless a healthy kidney is to be planted into the area immediately.
- The incision is stitched back up with sutures or closed with surgical staples.
Laparoscopic Nephrectomy Procedure
This procedure can be used for simple or partial types of nephrectomy.
- You will be laid on your back and an incision of about 8 to 12 inches will be made on your abdomen just below your ribs.
- The ureter and blood vessels of the kidney are tied off and cut, and the kidney is taken out with the surrounding fat, adrenal glands, and lymph nodes.
- The ureter and blood vessels left are stitched close.
- The incision is sutured back with stitches or surgical staples.
(For partial nephrectomy, the site is monitored as the surgical instrument cut away and remove the diseased and damaged part of the kidney.)
- Four incisions are made on your abdomen; 3 of these incisions are 1 inch each and the last one which is usually just below your navel will be about 4 to 5 inches.
- Through the incisions, a laparoscope with a small camera will be inserted to monitor the inside and guide the surgical instruments that are also inserted through the incisions. The surgeon monitors the movement of the laparoscope and instruments through a computer or magnifying telescope.
- With the guide of the laparoscope, the surgeon directs the surgical instrument to detach the ureter and blood vessels of the kidney from the body.
- After the kidney is detached, the kidney is lifted out through the large incision, by placing a soft sling under the kidney and drawing the edges out.
The duration of these surgeries is often between 2 to 3 hours. The laparoscopic procedure takes longer than simple or radical procedures because the surgeon has to be very careful as he views the internal body through a camera and is at risk of injuring the surrounding organs, nerves, tissues, etc.
After the Surgery,
A tube may be connected to through the incision and taped to drain out excess fluids in the surgical area. It can be left for 24 to 36 hours. The incision will be wiped clean and bandaged and you will be moved to your room to recover and come out of your sedated state.
You will be required to stay at the hospital for days to weeks for close monitoring until you are considered fit enough to leave.
Laparoscopic nephrectomy heals faster than other nephrectomy procedures. However, your rate of recovery is based on the type and surgical method of nephrectomy used, your body type, and how well you keep to the post-operative instructions as directed by your surgeon.
Keep your surgical site and incision clean, dry, and sanitized always to avoid infections. Make sure to abstain from any strenuous activity till you are fully healed which your surgeon will relay to you. Make sure to meet with your doctor for regular follow-up checks till he says otherwise.
Eat healthily, avoid any diet that can culminate in ruining your kidney. Quit smoking, use of street drugs, and intake of alcohol.
- The incisions are sutured back with stitches or staples.
What is the difference between radical nephrectomy and nephroureterectomy?
Radical nephrectomy is the removal of the kidney along with the surrounding fat, adrenal gland, and lymph nodes. While nephroureterectomy is the removal of the entire ureter and kidney, along with the renal pelvis and bladder cuff. However, both are used to treat kidney diseases.
Which doctor should I consult for nephrectomy?
Consult a surgeon, mainly a urologist.
Why is the left kidney usually chosen?
The left kidney is often chosen for nephrectomy because it is easier to reach and has longer blood vessels. The liver obstructs the right kidney, making it difficult to reach and a high risk of puncturing the liver.
Can I live a normal life with one kidney?
Yes, you can. One healthy kidney can work just as well as two. You can live a normal life and have the same life span as any other person with two kidneys. But you have to be cautious about your lifestyle, habits, and diet because you are at risk of losing kidney function faster if there is just one kidney left with no other one to share the burden.
What should you not eat with one kidney?
Avoid or minimize the intake of any food with too much cholesterol in them and saturated trans-fat. They can raise your blood sugar and in the long-term damage your kidney. These include milk, sweets, starch, red meat, butter, palm oil, etc. Eat a lot of vegetables, fruits, and whole grains.