Definition

Nephrectomy is the surgical procedure of removing a kidney or section of a kidney.

  Purpose

Nephrectomy, or kidney removal, is performed on patients with cancer of the kidney (renal cell carcinoma); a disease in which cysts (sac-like structures) displace healthy kidney tissue (polycystic kidney disease); and serious kidney infections. It is also used to remove a healthy kidney from a donor for the purposes of kidney transplantation.

  Precautions

Because the kidney is responsible for filtering wastes and fluid from the bloodstream, kidney function is critical to life. Nephrectomy candidates suffering from serious kidney disease, cancer, or infection usually have few treatment choices but to undergo the procedure. However, if kidney function is lost in the remaining kidney, the patient will require chronic dialysis treatments or transplantation of a healthy kidney to sustain life.

  Description

Nephrectomy may involve removing a small portion of the kidney or the entire organ and surrounding tissues. In partial nephrectomy, only the diseased or infected portion of the kidney is removed. Radical nephrectomy involves removing the entire kidney, a section of the tube leading to the bladder (ureter), the gland that sits atop the kidney (adrenal gland), and the fatty tissue surrounding the kidney. A simple nephrectomy performed for transplant purposes requires removal of the kidney and a section of the attached ureter. A similar procedure is used to harvest cadaver kidneys, although both kidneys are typically removed at once (bilateral nephrectomy) and blood and cell samples for tissue typing are also taken.

The nephrectomy patient is administered general anesthesia and the surgeon makes an incision on the side or front of the abdomen. Muscle, fat, and tissue are cut away to reveal the kidney. The blood vessels connecting the kidney to the circulation are cut and clamped. Depending on the type of nephrectomy procedure being performed, the ureter, adrenal gland, and/or surrounding tissue may also be cut. The vessels and the ureter in the patient are then tied off and the incision is sewn up (sutured). The surgical procedure can take up to three hours, depending on the type of nephrectomy being performed.

Laparoscopic nephrectomy is a form of minimally-invasive surgery that utilizes instruments on long, narrow rods to view, cut, and remove the kidney. The surgeon views the kidney and surrounding tissue with a flexible videoscope. The videoscope and surgical instruments are maneuvered through four small incisions in the abdomen. Once the kidney is freed, it is secured in a bag and pulled through a fifth incision, approximately 3 in (7.6 cm) wide, in the front of the abdominal wall below the navel. Although this surgical technique takes slightly longer than a traditional nephrectomy, preliminary studies have shown that it promotes a faster recovery time, shorter hospital stays, and less post-operative pain for kidney donors.

  Preparation

Prior to surgery, blood samples will be taken from the patient to type and crossmatch in case transfusion is required during surgery. A catheter will also be inserted into the patient's bladder. The surgical procedure will be described to the patient, along with the possible risks.

  Aftercare

Nephrectomy patients may experience considerable discomfort in the area of the incision. Patients may also experience numbness, caused by severed nerves, near or on the incision. Pain relievers are administered following the surgical procedure and during the recovery period on an as-needed basis. Although deep breathing and coughing may be painful due to the proximity of the incision to the diaphragm, breathing exercises are encouraged to prevent pneumonia. Patients should not drive an automobile for a minimum of two weeks.

  Risks

Possible complications of a nephrectomy procedure include infection, bleeding (hemorrhage), and post-operative pneumonia. There is also the risk of kidney failure in a patient with impaired function or disease in the remaining kidney.

Normal results

Normal results of a nephrectomy are dependent on the purpose of the procedure and the type of nephrectomy performed. Immediately following the procedure, it is normal for patients to experience pain near the incision site, particularly when coughing or breathing deeply. Renal function of the patient is monitored carefully after nephrectomy surgery. If the remaining kidney is healthy, it will increase its functioning over time to compensate for the loss of the removed kidney.

Length of hospitalization depends on the type of nephrectomy procedure. Patients undergoing a laparoscopic radical nephrectomy may be released within two to four days after surgery. Traditional open nephrectomy patients are typically hospitalized for about a week. Recovery time will also vary, on average from three to six weeks.

   Key Terms:

Cadaver kidney A kidney from a brain-dead organ donor used for purposes of kidney transplantation. Polycystic kidney disease A hereditary kidney disease that causes fluid- or blood-filled pouches of tissue called cysts to form on the tubules of the kidneys. These cysts impair normal kidney function. Renal cell carcinoma Cancer of the kidney.

   Resources:

Books

• Brenner, Barry M., and Floyd C. Rector Jr., eds. The Kidney. Philadelphia: W. B. Saunders Co., 1991.
• Cameron, J. S. Kidney Failure: The Facts. New York: Oxford University Press, 1996.
• Ross, Linda M., ed. Kidney and Urinary Tract Diseases and Disorders Sourcebook. Vol. 21. Detroit: Omnigraphics, Inc., 1997.

Periodicals

• McDougall, Elspeth. "Laparoscopic Radical Nephrectomy for Renal Tumor: The Washington University Experience." The Journal of the American Medical Association 275, no. 24 (June 1996): 1180-5.

Organizations

• National Kidney Foundation. 30 East 33rd St., New York, NY 10016. (800) 622-9010. http://www.kidney.org