Types of Nephrectomy
The main types of nephrectomy are:
- Radical Nephrectomy: Also known as complete nephrectomy, the urologic surgeon removes the entire kidney, ureter or other adjacent structures such as the adrenal gland or lymph nodes. If both kidneys need to be removed, this is called bilateral nephrectomy.
- Partial Nephrectomy: The surgeon removes only the part of the kidney that is affected, also called as nephron-sparing surgery or kidney-sparing surgery
- Simple Nephrectomy: The surgeon removes only the kidney.
Medical tests are done to check the functioning of the kidney, GMR, urine protein, etc. Imaging tests aid in determining whether partial or complete nephrectomy is the best surgical approach. The imaging tests include:
- Computerized tomography (CT
- Magnetic resonance imaging (MRI)
Procedure of Nephrectomy
- The surgeon will discuss with you the type of procedure best suited and the outcomes of the surgery.
- Instruct you to stop taking blood thinners, anti-inflammatory medications and certain vitamin supplements before surgery.
- Advice to stop smoking as it delays healing.
- Standard tests are performed to check fitness for surgery
Nephrectomy is done under general anaesthesia. Laparoscopic nephrectomy surgery takes approximately 2 to 2-1/2 hours. The procedure is performed either as open surgery, laparoscopic or robotic surgery.
- Open Nephrectomy: An incision is made in the front or side of the abdomen. The ureter and the surrounding blood vessels are detached and the kidney is removed via the incision. The opening is then closed with stitches. The incision will leave a scar that will fade with time.
- Laparoscopic Nephrectomy: This procedure is minimally invasive than open surgery, and the recovery time is much quicker. The doctor will insert a thin tube (laparoscope) and surgical tools through three or four small abdominal incisions. The kidney is removed through one of the incisions. The incisions will leave smaller scars as compared to open surgery.
- Robot-assisted laparoscopic surgery: The surgeon controls the robotic arms that hold the tools and scope. Robotic tools require very small incisions, provide better 3-D images during the procedure, and can make fine or complex motions that are similar to what a surgeon's hand can do in open surgery.
- Recovery time taken will be different for each patient and the procedure used
- Patients who have had laparoscopic surgery will usually stay in the hospital for 2-3 nights
- Those who have had open surgery stay for 5-7 nights.
- Immediately after surgery, patients are monitored for blood pressure, electrolyte levels, and fluid balance
- Patients will often have a urinary catheter in their bladder for a short time after surgery to drain urine.
- Pain and numbness at the incision site are common for a period after the surgery.
- Deep breathing exercises are recommended following nephrectomy to prevent postoperative pneumonia
Follow up after Surgery
Most people can function well with only one kidney, but regular checkups to monitor the kidney function are essential, tests like
- Blood pressure: Decreased kidney function can increase blood pressure
- Protein urine levels: High urine protein levels (proteinuria) may indicate poor kidney function.
- Waste filtration: Reduced Glomerular filtration rate indicates decreased kidney function.
Risks and Side Effects
There are a few risks associated with Nephrectomy,
- Allergic reaction
- Pulmonary embolism – the formation of a blood clot in legs that may move into the lungs
- A hernia can occur in the area of the incision
- Heart attack or stroke
- Postoperative pneumonia
- Injury to organs or tissue around the kidney
- Kidney failure