Nephrectomy, commonly known as kidney removal, is a surgical procedure performed to remove either part or all of a kidney. This intervention becomes necessary for various medical conditions affecting kidney health or as part of an organ donation process. The goal of a nephrectomy is often to address disease, alleviate symptoms, or facilitate life-saving transplantation.
Reasons for Kidney Removal
Kidney removal is performed for a range of medical reasons, with kidney cancer being a frequent indication. When a kidney is affected by cancer, particularly renal cell carcinoma, a nephrectomy can be a primary treatment to remove the tumor. The procedure may also be necessary for kidneys that have sustained severe damage from injury, chronic infection, or extensive kidney stones, especially if the damage impairs function or causes recurring issues. Furthermore, non-functional kidneys that lead to persistent infections or contribute to high blood pressure may require removal. Living kidney donation is another common reason for nephrectomy.
Approaches to Kidney Removal Surgery
Surgeons employ different techniques to remove a kidney, each with distinct characteristics regarding incisions and recovery. The traditional method is an open nephrectomy, which involves making a single, larger incision in the abdomen or on the side, just below the ribs. This approach allows the surgeon direct visibility and access to the kidney and surrounding structures, sometimes requiring the removal of a rib for better access. Open surgery may be chosen for large tumors or complex cases where minimally invasive options are not feasible.
Laparoscopic nephrectomy represents a minimally invasive approach, utilizing several small incisions in the belly and side. Through these small openings, specialized instruments and a thin tube with a camera, called a laparoscope, are inserted to visualize the internal organs on a monitor. This technique results in less pain, smaller scars, shorter hospital stays, and a quicker recovery compared to open surgery. The kidney is typically detached inside the body and then removed through one of the small incisions, which may be slightly enlarged, or by placing it in a bag and pulling it through.
Robotic-assisted nephrectomy is a variation of laparoscopic surgery that enhances the surgeon’s capabilities. In this method, the surgeon controls robotic arms from a console, translating their hand movements into precise, magnified movements of surgical instruments inside the patient’s body. This robotic assistance can provide enhanced dexterity, improved visualization, and greater precision, which can be particularly advantageous for complex dissections or when preserving kidney tissue in partial nephrectomies.
The Surgical Procedure
Regardless of the specific approach, kidney removal surgery follows a general sequence of steps. The patient first receives general anesthesia. Once anesthesia is administered, the patient is carefully positioned on the operating table, often on their side, to provide optimal access to the kidney. The surgical area is then prepared and draped, and the initial incision or incisions are made.
The surgeon then dissects and isolates the kidney from surrounding tissues, organs, and fatty layers. This separation is necessary to gain clear access to the kidney’s blood supply and the ureter, the tube that carries urine from the kidney to the bladder. The renal artery and renal vein, which supply and drain blood from the kidney, along with the ureter, are identified. These vessels and the ureter are then ligated and subsequently divided.
After the kidney is fully detached and its connections are secured, it is removed from the body through the designated incision. In cases of radical nephrectomy, surrounding fat, the adrenal gland, and sometimes nearby lymph nodes may also be removed. Once the kidney is extracted, the surgical field is inspected for any bleeding, and then the incisions are closed using sutures, staples, or surgical glue. A temporary drain or urinary catheter may be placed to manage fluid drainage and monitor urine output during the initial recovery period.
Post-Surgery Recovery and Care
Following kidney removal surgery, patients are closely monitored in a recovery area as they awaken from anesthesia. The hospital stay ranges from one to seven days, depending on the type of nephrectomy performed and the patient’s overall health. Pain management is a priority, with medications administered to control discomfort. Vital signs are continuously monitored to ensure stability, and the function of the remaining kidney is assessed through blood tests and urine output.
Patients are encouraged to begin light activities, such as sitting up and walking, as soon as medically appropriate. Early mobilization helps prevent complications like blood clots and promotes lung health. While light activity is encouraged, strenuous activities, heavy lifting, and vigorous exercise should be avoided for at least six weeks to allow for proper healing. Dietary considerations may include starting with clear liquids and gradually advancing to a regular diet, with an emphasis on adequate hydration and fiber to prevent constipation.
Follow-up appointments with the surgical team are scheduled to monitor recovery, remove any drains or sutures, and discuss pathology results if the surgery was for cancer. For individuals living with one kidney, the remaining kidney compensates and can maintain adequate function. Long-term care involves regular monitoring of kidney function, blood pressure, and adopting a healthy lifestyle to support the health of the solitary kidney.