Definition and Overview

Nephrectomy is a surgical procedure that removes the kidneys. It can be partial (when only one of the kidneys is removed) or simple (both are removed). It can also be radical if both the kidneys, the tube that connects the bladder to the ureter, and nearby lymph nodes are also removed.

Many conditions can affect the structure and performance of the kidneys. While minor cases can be treated with medications and lifestyle modifications, nephrectomy is considered for severely damaged kidneys or in the case of kidney failure that endangers the person’s health. A kidney transplant often follows the surgery if both the kidneys are removed.

Who Should Undergo and Expected Results

Kidney removal is performed when the patient is diagnosed with:

  • Kidney cancer – Also called renal cancer, it is one of the most common types of cancer that affect men and women in the United States. Of all the kidney cancers, the most commonly diagnosed is renal cell carcinoma, and it is normally seen among adults. There is no standard screening for kidney cancer, but it can be detected early through blood tests and urinalysis.

  • Chronic kidney disease – Chronic kidney disease (CKD) is a long-term malfunction of the kidneys. Risk factors include diabetes, hypertension and heredity. CKD is often diagnosed when the condition has already deteriorated since it doesn’t present any obvious symptoms in the earliest stages. The condition can also lead to kidney failure. If the condition is deemed irreversible, the patient is placed on dialysis or advised to undergo a liver transplant.
    Other reasons for nephrectomy are:

  • Chronic kidney infections

  • Trauma to the kidneys
  • Poor growth and development of the kidneys
  • Congenital defect
  • Renovascular hypertension
  • Reflux dysplasia
  • Pyelonephritis
  • Polycystic kidney disease
  • Dialysis failure

How Does the Procedure Work?

Prior to the kidney removal, the patient undergoes a series of tests to ensure that he is eligible and ready for the procedure. These include imaging exams that can indicate the exact position of the tumour, the condition of the kidneys and the best points to make the incision. The surgeon then decides whether the patient needs a partial or radical nephrectomy, as well as laparoscopic or open technique.

In an open technique, one large incision that is about 10 to 20 centimeters long is made either on the side of the abdomen or right in the abdominal area to access the kidneys. The muscles and tissues are then cut to reveal the kidneys. Using surgical tools, the tube that connects the kidneys and the ureter is cut. The kidneys are then removed. Depending on the patient’s condition, the adrenal glands and lymph nodes may also be removed. The incision is then closed with either staples or sutures. The kidneys are then sent to the lab to check for possible cancer metastasis.

In a laparoscopic or keyhole surgery, four small incisions around 7 centimeters long are created in the abdominal area and the side of the body. A newer technique involves using only one port or incision measuring 11 to 20 millimeters in the belly button or navel. One of the incisions is used to insert a laparoscope, a long flexible tube with an attached camera and light. The device is connected to a monitor, which receives real-time images from the camera. Once the surgeon is ready to operate, he makes one of the incisions larger to access the kidney, place a bag that wraps around the kidney, cut the kidney, and pull it out.

These days, certain hospitals and surgeons also offer another surgical option called robotic-assisted surgery, which means there’s less manual work for the surgeon. The surgeon simply manipulates robotic arms and monitors the procedure.

Possible Risks and Complications

Kidney removal may cause common surgical risks and complications such as blood loss, internal bleeding, infection and pain. Thus, patients are provided with antibiotics and pain relievers.

In some cases, patients also experience:

  • Breathing problems
  • Damage to the nearby organs and tissues
  • Formation of blood clots
  • Allergic reactions to the medications or anesthesia
  • Failure of the remaining kidney
  • Sepsis
  • Coma and death
    The surgeon should discuss these risks and complications to the patient before the procedure. The surgery also requires both short- and long-term management and follow-ups.

    References

  • Kavoussi LR, Schwartz MJ, Gill IS. Laparoscopic surgery of the kidney. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 55.

  • Kenney PA, Wotkowicz T, Libertino JA. Contemporary open surgery of the kidney. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 54.

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