What Is It?
A nephrectomy is the surgical removal of a kidney, the organ that filters waste from the blood and produces urine. There are normally two kidneys, right and left, and each is about 4 to 5 inches long. They are located at the back of the abdomen just below the diaphragm, behind the liver on the right, and the spleen on the left. A portion of each kidney is protected by the lowest one or two ribs and also by the muscles that cover the back and side of the body. Depending on the reason for a nephrectomy, all or part of one kidney or both kidneys will be removed according to the following:
- Partial nephrectomy — Only part of one kidney is removed.
- Simple nephrectomy — All of one kidney is removed.
- Radical nephrectomy — All of one kidney is removed together with the neighboring adrenal gland (the adrenaline-producing gland that sits on top of the kidney) and neighboring lymph nodes.
- Bilateral nephrectomy — Both kidneys are removed.
A nephrectomy usually is performed using a conventional open surgical approach, although a newer laparoscopic approach is now available as an alternative for selected patients in a limited number of medical centers.
In a conventional open nephrectomy, the surgeon removes the kidney through a standard incision (surgical cut) about 12 inches long. When possible, this incision is made in the flank (side of the body) to allow the surgeon to access the kidney while only minimally disturbing the abdominal organs. However, depending on the reason for the nephrectomy and the health status of the patient, an alternative approach may involve an incision made in the front of the abdomen or in the back.
In the newer, less-invasive laparoscopic nephrectomy, four small incisions are made in the wall of the abdomen, and the doctor uses a laparoscope (a tubelike instrument with a camera for viewing inside the body) to guide his or her surgical instruments. Both conventional open nephrectomy and laparoscopic nephrectomy are performed under general anesthesia, so that the patient is not awake during the procedure.
A laparoscopic nephrectomy usually produces less postoperative pain than a conventional open nephrectomy, and it also allows a quicker recovery period with less-obvious scarring. However, it takes longer than an open nephrectomy, requires a surgeon who is skilled in laparoscopy and is currently available to only a limited number of people.
What It’s Used For
A conventional open nephrectomy may be used to remove a kidney for the following reasons:
- The kidney has a malignant (cancerous) tumor. In this case, a radical nephrectomy usually is done.
- The kidney has been irreparably damaged by pyelonephritis (kidney infection), nephrolithiasis (kidney stones), hydronephrosis (kidney damage due to an obstruction of urine outflow) or kidney cysts.
- The patient has severe hypertension (high blood pressure) that is related to his or her kidneys.
- Severe trauma has damaged the kidney beyond repair.
- A living donor has agreed to donate one kidney for transplantation.
- A transplanted kidney has been irreversibly rejected by the recipient’s body and is not functioning. This is called an allograft nephrectomy and is different surgically from removal of the patient’s own kidney.
Laparoscopic nephrectomy has been used as an alternative to a conventional nephrectomy in selected patients, especially in removing kidneys for transplantation from live donors.
About one week before surgery, you will be told to stop taking aspirin and other blood-thinning medications. Beginning at midnight on the night before surgery, you must not eat or drink anything. This reduces the risk of vomiting during surgery. As part of the general preparations for surgery, your doctor will review your allergies and your medical and surgical histories. If you are a woman, and there is any chance that you might be pregnant, you must inform your doctor of this prior to surgery.
How It’s Done
An intravenous (IV) line will be inserted into one of your veins to deliver fluids and medications, and general anesthesia will be given.
- Simple nephrectomy — If your nephrectomy is to be performed through an incision in your flank (a cut in your side), the procedure will be performed on an angled operating table. You will lie on your side with your body bent sharply at the waist. This position puts some stretch on the side on which surgery will be performed, and it makes the kidney more accessible to the surgical team. An angled incision will be made through the skin and muscle of your side, either along the lower border of your ribs, or near your 11th or 12th rib. This incision typically extends from your spine, around your side, to the front of your abdomen. If necessary, a portion of one or two ribs will be removed to expose your kidney better. Any neighboring organs will be moved aside gently. The kidney’s blood vessels and ureter will be tied off and cut, and the kidney will be lifted out of your body. The lower layers of the incision will be closed with sutures, and the upper layer of skin will be closed with either sutures or surgical staples. In some cases, a temporary drainage tube will be inserted to drain fluids from the wound area. Following surgery, you will be taken to the recovery room, where you will be monitored for several hours until you are stable enough to return to your hospital room. After about 24 to 48 hours, the drainage tube will be removed, but you probably will remain in the hospital for a total of five to seven days.
- Radical nephrectomy — The procedure for a radical nephrectomy is similar to that for a simple nephrectomy, except that the incision often is made in the front of the abdomen, and it may even extend into the lower portion of the chest. Usually, this incision is larger than that for a simple nephrectomy, especially if the surgery is being performed to remove a large tumor involving the upper portion of the kidney. In a radical nephrectomy, the neighboring lymph nodes and adrenal gland are removed together with the kidney.
- Laparoscopic nephrectomy — In a laparoscopic nephrectomy, a laparoscope and small surgical instruments will be inserted into your abdomen through four small incisions (each incision is about 12 millimeters long). Then the surgeon will use a tiny camera on the laparoscope to guide the surgical instruments in freeing your kidney. Toward the end of the procedure, one of the small incisions (usually one located just below the navel) will be enlarged slightly to allow the kidney to be lifted out of your body. At the end of the procedure, the small abdominal incisions will be closed with sutures or surgical tape.
About one week after you return home from the hospital, you will visit your doctor for follow-up. At this visit, your doctor will check the healing of your incision and suggest a time frame for resuming your normal activities. For most people who have had conventional open surgery, full recovery takes about six weeks.
In most healthy people who have only one kidney removed, the remaining kidney can compensate for the loss of its partner. Overall kidney function stabilizes, and there is normal life expectancy. People who have both kidneys removed will need dialysis or a kidney transplant.
The risks depend on the type of nephrectomy (simple, radical, bilateral, laparoscopic) and on the surgical approach (location of the incision). Some risks include:
- Injury to neighboring abdominal organs, such as the intestines, liver, spleen and pancreas
- Hemorrhage (bleeding), either inside the abdomen or from the surgical wound
- An accidental cut or puncture into the chest cavity, causing a collapsed lung (pneumothorax)
- A temporary decrease in lung function immediately after surgery
- Wound infection
- Temporary decrease in overall kidney function (if only one kidney was removed)
- Injury to nerves near the site of the incision
- Incisional hernia
Radical nephrectomy is generally a very safe surgical procedure that carries a 2 percent risk of death; however, about 20 percent of patients have major or minor postoperative complications.
When To Call A Professional
Once you return home from the hospital, call your doctor immediately if:
- You develop a fever
- Your incision becomes red, tender or swollen
- You experience nausea, vomiting or severe abdominal pain
- You develop a cough or have difficulty breathing
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.