A nephrectomy is a surgical procedure in which a kidney is partially or completely removed. This procedure is carried out when a patient has a severely damaged kidney which can no longer function effectively. A wide range of diseases may cause such damage, including diabetes, kidney cancer, polycystic kidney disease, and severe infection. A kidney may be removed without being replaced, or may be replaced by a donor kidney in the case of a transplant operation.
A nephrectomy may be a full or partial procedure. A partial kidney removal means that only a portion of a diseased kidney is removed. In a complete kidney removal, an entire kidney is removed, together with some of the tissue which surrounds the organ. This procedure is also called a radical kidney removal, and involves the removal of the kidney, part or the ureter, and the adrenal gland adjacent to the kidney.
In an open nephrectomy, a surgeon makes an incision of around 6 to 10 inches (15 to 25 cm) in length below the ribcage to expose the kidney. The incision may be made on the front of the abdomen or on the side. The vessels feeding the kidney are clamped and then cut. The ureter, which connects the kidney to the bladder, is also cut. Finally, the kidney is removed, and the incision is closed. This procedure usually takes approximately three hours.
A laparoscopic nephrectomy is a similar procedure, but in this case three or four small incisions are made instead of one large one. Through these tiny incisions, the surgeon works to remove the kidney with special tools and a miniature camera which allows him or her to see inside the body without making a large incision. Laparoscopic surgery provides several advantages to the patient in that it is much less invasive than open surgery, with fewer risks and side effects, and a faster recovery time.
To prepare for a nephrectomy, a patient is given instructions about eating and drinking before the surgery. They may be asked to stop taking certain medications, such as blood thinners, one or more days prior to the procedure. Before the procedure the patient is catheterized, so that urine flow does not complicate the surgery.
After the procedure is complete, pain at the incision site, along with possible numbness, is common for most patients. Coughing and deep breathing may be painful, due to the surgical incision, but it is important for patients to breathe deeply to prevent the development of pneumonia. Complications of a kidney removal may include infection of the incision site, internal bleeding, and pneumonia.
If a patient’s kidney was removed due to disease or damage, there is a risk of subsequent reduced function or failure of the remaining kidney. Someone who has a kidney removed because they have consented to act as a living donor, they are also at risk in the future. This is because they are vulnerable to toxicity, infection, or injury which may damage their remaining kidney.