Nephrectomy (removal of the kidney)

NEPHREECTOMY

What is nephrectomy? Type of anesthesia

Nephrectomy is the surgical intervention in which a complete kidney or part of kidney is removed. It may require:

• Removal of part of the kidney (partial nephrectomy).
• Removal of an entire kidney (simple nephrectomy).
• Removal of the entire kidney, surrounding fat and adrenal gland, as well as nearby lymph nodes (radical nephrectomy).

This procedure is performed under general anesthesia and usually takes about three hours or more.

Why is it performed?

Nephrectomy is performed:

• When there are kidney tumors, such as hypernephroma.
• If the kidney is severely affected by benign diseases, such as hydronephrosis.
• When the kidney is damaged by infection, kidney stones or other problems.
• When there is trauma resulting in severe injury to the kidney.
• When someone donates a kidney.
• If there are congenital defects.
• To control high blood pressure in people who do not have a good blood supply.

What does it consist of?

The procedure during the operation will depend on the type of nephrectomy to be performed:

1. Simple nephrectomy: The patient is made to lie on his or her side. The specialist will make an incision of up to 30cm in one of the sides, just above the ribs. The cut will remove muscle, fat and tissue. It may be necessary to remove a rib. The surgeon will then cut the tube that carries urine from the kidney to the bladder (ureter) and the blood vessels and then remove the kidney. Finally, the incision will be closed with stitches and staples.

2. Radical nephrectomy: The surgeon will make a 20-30cm incision in the front part of the abdomen, below the ribs. This procedure can also be performed through the side. In the same way, muscle, fat and tissue will be removed. The ureter and blood vessels will also be cut to remove the kidney. In addition to the fat, it is sometimes necessary to remove the adrenal gland and some lymph nodes. The surgery will finally be closed with stitches or staples.

3. Laparoscopic kidney surgery: The surgeon will make three or four small cuts (no larger than 2.5 cm) in the abdomen and side, which will be used to use tiny probes and a camera to perform the surgery. The surgeon will enlarge one of the cuts later (up to 10cm) in order to remove the kidney. The surgeon will also cut the ureter, place a bag around the kidney, and remove it through the larger incision. It is a surgery that can be longer than open nephrectomy, but a better recovery is achieved, with less pain.

Preparation for nephrectomy

As in any surgery, the doctor should always be informed about the possibility of being pregnant and the type of medication the patient is taking.

During the days prior to surgery, the patient will undergo blood tests in case a transfusion is necessary during the operation. Likewise, the specialist may ask the patient to stop taking acetylsalicylic acid, some types of anti-inflammatory drugs and some anticoagulants.

It is recommended not to smoke, which will favor recovery.

During the same day of the intervention, the patient will be asked not to eat or ingest anything after the previous midnight. You should also take the medications prescribed by the doctor.

Care after the operation

The patient will be admitted to the hospital for two to seven days after the operation, depending on the type of operation. During hospitalization:

• Practitioners may ask the patient to sit on the edge of the bed and walk on the day of the procedure.
• The patient may have a catheter or tube from the bladder.
• You may have a drain from the surgical incision.
• The patient will not be able to eat for the first 3 days after surgery and then start drinking liquids.
• The professionals will recommend the patient to do breathing exercises.
• The professionals will give the patient anticoagulant injections.
• Painkillers may be required.

In general, open procedures are painful. In contrast, recovery after laparoscopy will be quicker and less painful.