Nephrectomy

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.