What is nephrectomy?

It is a kidney surgical removal procedure, undertaken to treat a variety of disorders including cancer. It is often required to extract a normal healthy organ for the transplant operation, from a living or deceased donor.

Radical (complete). In this procedure, the whole organ along with some external structures, such as part of the tube that links the kidney to the bladder (ureter), or other neighboring structures such as the adrenal gland or lymph nodes are also removed. 

Partial. Excision of diseased tissue from an organ is a partial nephrectomy, also called kidney-sparing (nephron-sparing) procedure, and leaves healthy tissue in place.

Indications

There are various reasons for this nephrectomy which includes renal cell carcinoma, a non-functioning (which can cause elevated blood pressure) and a congenitally small kidney (in which the it swells, causing it to push on nerves which may cause pain in unrelated areas such as the back).

Nephrectomy is increasingly being updated for renal cell carcinoma to allow partial removal. It is also performed for the purpose of living donor transplantation. A nephroureterectomy is the removal of a kidney and the whole ureter and a small bladder cuff for ureter urothelial cancer.

Procedures

Laparoscopic nephrectomy:

Under general anesthesia the surgery is carried out. It may be removed laparoscopically or through an open incision. The laparoscopic technique uses 3 or 4 minimal (5–10 mm) cuts in both the abdominal and flank regions. Within the body it is completely removed and then placed in a bag. In cancer procedures, one of the incisions is then extended to cover it. When the kidney is removed for other reasons, it may be morceled through the tiny incisions and removed. When this procedure is performed in the patient’s navel by a single incision, this sophisticated technique is called laparoscopy of single ports.

Partial Nephrectomy: 

Partial nephrectomy with a patient is also performed under general anesthesia. The patient is placed on the bed of the operating room, lying opposite the tumor on the hand. The purpose of the operation is to remove the tumor along with a thin rim of normal organ tissue. Blood flow to this organ is often temporarily blocked off to safely remove the tumor. The tumor is then taken out, and the surgeon has to stitch back together the remaining kidney. With renal cell cancer, partial nephrectomy is also an alternative to complete, or radical.

Preparing for the surgery

All the risks, benefits and treatment options are discussed with each patient prior to surgery. Decisions regarding radical or partial nephrectomy and open or laparoscopic surgery will be taken by the surgeon based on the investigations and clinical condition of the patient.

Patient will also be explained the need (if any) for radical, even though the patient is planned for partial nephrectomy. And if the patient is suffering from cancer then other procedures that might also be required will be discussed.

The patient and caretakers will be advised about fasting, taking of prescription medication, timing of medication prior to surgery, medications that need to be avoided and what all preparations to be done before reaching hospital and what needs to be done during the hospital.

Postoperative Care

During the surgery, pain medicine is also given to the patient due to discomfort at the incision site. An IV is administered with fluids. Electrolyte balance and fluids are carefully monitored, since these are it’s functions. The remainder of the kidney may not take over all functionality. Depending on the procedure and complications a patient must stay in the hospital between 2 and 7 days. Patients who have had open surgery would be expected to remain longer in hospital than patients who have had laparoscopic surgery. A person with only one kidney may be more likely to develop chronic disease in the long term.

Complications

Patients undergoing partial nephrectomy experience complications between 15-25% of the time. Bleeding, inflammation and urinary leakage represent the most common complications.

Long-term complications are linked to possible living issues with less than two complete, fully functioning kidneys. Although general function of the kidney decreases after the procedure, the remaining kidney tissue usually works well enough for a healthy life. High blood pressure (hypertension) and chronic kidney disease are the two most common long-term complications.

Potential risks and complications depend on the type of operation, the reasons for the procedure, general health of the patient and many other factors, including skill and experience in operation.

Function monitoring

Generally, the majority of the patients work normally with a solitary kidney, but require regular checkups to monitor following parameters which are essential for its functioning. They are blood pressure monitoring – as high blood pressure can damage it; urinary protein levels – high levels show organ damage or poor functioning; glomerular filtration rate (GFR) – shows the efficiency of filtration by the kidney. A reduction in GFR shows reduced function.

Taking care

Post radical or partial nephrectomy, the kidney function is normal and to preserve this normal functioning, the patient is advised to have a regular balanced diet, perform some physical activities and activities and to come for regular follow-ups. A holistic approach will preserve the normal functioning of the kidney for a long period of time.