Nephrectomy

What is Nephrectomy?
Nephrectomy is a surgical procedure in which a kidney or a part of a kidney is removed. A nephrectomy is performed if the kidney is severely damaged due to disease or injury or if the kidney is malfunctioned due to congenital conditions. The kidney may become damaged due to cancer, infections or polycystic kidney disease. A nephrectomy is also performed on a kidney donor for kidney transplantation.

What are the types of Nephrectomy?

• Radical Nephrectomy: In a radical nephrectomy, the kidney, surrounding lymph nodes, adrenal gland and the fatty tissue surrounding the kidney are removed.
• Simple Nephrectomy: In a simple nephrectomy, only the damaged kidney is removed. A simple nephrectomy may also be performed on a kidney donor.
• Partial Nephrectomy: In a partial nephrectomy, only the tumor or an infected portion from a diseased kidney is removed, keeping the rest of the kidney intact.

How is a nephrectomy performed?

A nephrectomy is performed in the following ways:

• Simple and Partial Open Nephrectomy:
  During an open surgery for a simple and partial nephrectomy, the patient is required to lie on one side. An incision of about 12 inches long is made on the side of the patient's abdomen, beneath the ribs. Muscle and fat tissues are removed. Sometimes the patient's rib may also be removed for the surgery. The ureter and blood vessels attached to the kidney are cut and clamped, after which the kidney is removed. The incision is closed with stitches or staples.
• Radical Open Nephrectomy
  In an open surgery for a radical nephrectomy, an incision of about 8 to 12 inches long is made in the front part of the abdomen, beneath the ribs. This surgery may also be done through the side of the patient's abdomen. Then, the ureter and blood vessels attached to the kidney are cut and clamped, after which the kidney is removed. The adrenal gland and lymph nodes are also removed during this surgery. The incision is then closed with stitches or staples.
• Laparoscopic Surgery:
  A laparoscopic surgery may be used to perform a nephrectomy. During this, 3 to 4 small incisions are made on the side of the patient's abdomen. Surgical instruments along with a videoscope are inserted through the incisions. Air is pumped into the abdomen to inflate it for better view. The ureter and kidney is cut. The kidney is placed in a bag and pulled out through a fifth incision, which is made towards the end of the surgery. The fifth incision is about 3 inches long and is made in the abdomen just below the navel. The kidney may also be removed with the surgeon's hand, out of the fifth incision, which should be about 3 to 5 inches long. The incisions are then closed with stitches or staples. Recovery from a laparoscopic surgery is considerably quicker than an open surgery.

How to prepare for a nephrectomy?

• The patient should inform the doctor about any medical conditions such as pregnancy or heart disease.
• The doctor should also be informed regarding any medication that the patient is taking. Certain medication needs to be stopped before the surgery.
• Blood samples are taken from the patient in case the patient needs blood transfusion.
• The patient should abstain from smoking some days before the surgery to enable a quick recovery.
• The patient should stop eating any solid or liquid food 12 hours before the surgery.
• A catheter is inserted into the patient's urinary bladder.
• The doctor will talk to the patient about the surger

How much time is required?
The procedure requires approximately 3 hours and the hospital stay is for about 2 to 7 days depending on the type of surgery.

What type of anesthesia will be given?

General Anesthesia

How will patient recover?

- Pain is normally felt in the incision area after the surgery. Pain medication may be provided.
- The patient's renal function is monitored after the surgery. If the remaining kidney is healthy, it will gradually enhance its functioning and recompense for the loss of the removed kidney.
- The patient may not be able to eat for 1 to 3 days after the surgery. If the doctor recommends, liquid diet may be given.
- Breathing exercises may be recommended to prevent pneumonia.
- The patient may need to wear special stockings and receive shots to prevent blood clots.
- The patient may fully recover in 3 to 6 weeks.

What should be cared?

- The patient should follow the doctor's instructions carefully.
- Physical activities like lifting weights, bending, etc. should be avoided.
- The incision stitches and wound should be kept dry and clean.
- Once the patient is allowed to bathe or shower after the surgery, the wound and stitches should be washed carefully. The wound should then be bandaged and kept dry.
The doctor should be informed immediately if the patient has the following symptoms:
- Chest pain and breathing difficulty
- Trouble passing urine or having a bowel movement
- Bleeding from the surgical wound
- Infection or swelling of the incision
- Fever
- Blood in the urine
- Itchy skin with rash
- Chills and cough