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Kidney removal

Definition

Kidney removal, or nephrectomy, is surgery to remove all or part of a kidney. It may involve:

• Part of one kidney removed (partial nephrectomy)
• All of one kidney removed (simple nephrectomy)
• Removal of one entire kidney, surrounding lymph nodes, and the adrenal gland (radical nephrectomy)

Alternative Names

Nephrectomy; Simple nephrectomy; Radical nephrectomy; Open nephrectomy; Laparoscopic nephrectomy; Partial nephrectomy

Description

This surgery is done in the hospital while you are asleep and pain-free (general anesthesia). The procedure can take 3 hours.

For simple nephrectomy or open kidney removal:

• You will be lying on your side. Your surgeon will make an incision (cut) up to 12 inches long. This cut will be on your side, just below the ribs or right over the last ribs.
• Muscle, fat, and tissue are cut and moved. Your surgeon may need to remove a rib to do the procedure.
• The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed.
• Sometimes, just a part of the kidney may be removed
• The cut is then closed with stitches or staples.

For radical nephrectomy or open kidney removal:

• Your surgeon will make a cut about 8 to 12 inches long. This cut will be on the front of your belly, just below your ribs. It may also be done through your side.
• Muscle, fat, and tissue are cut and moved. The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed.
• Your surgeon will also take out the adrenal gland and some lymph nodes.
• The cut is then closed with stitches or staples.

For laparoscopic surgery:

• Your surgeon will make 3 or 4 small cuts, usually no more than 1-inch each, in your belly and side. The surgeon will use tiny probes and a camera to do the surgery.
• Towards the end of the procedure, your doctor will make one of the cuts larger (around 4 inches) to take out the kidney.
• The surgeon will cut the ureter, place a bag around the kidney, and pull it through the larger cut.
• This surgery takes longer than an open kidney removal. Most people recover faster and feel less pain afterwards.

Sometimes, your surgeon may make a cut in a different place than described above.

Some hospitals and medical centers are doing this surgery using robots. See also: Robotic surgery

Why the Procedure Is Performed

Kidney removal may be recommended for:

• Someone donating a kidney
• Birth defects
• Kidney cancer
• A kidney damaged by infection, kidney stones, or other problems
• To help control high blood pressure in someone who has problems with the blood supply to their kidney
• Very bad injury (trauma) to the kidney that cannot be repaired

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Risks for this procedure are:

• Injury to other organs or structures
• Kidney failure in the remaining kidney
• After one kidney is removed, your other kidney may not work as well for awhile
• Hernia of your surgical wound

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

• You will have blood samples taken in case you need a blood transfusion.
• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), Clopidogrel (Plavix), warfarin (Coumadin), and other drugs like these.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Do not smoke. This will help you to recover quicker.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after midnight the night before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 2 to 7 days, depending on the type of the surgery you have. During a hospital stay, you may:

• Be asked to sit on the side of the bed and walk on the same day at surgery
• Have a tube, or catheter, that comes from your bladder
• Have a drain that comes out through your surgical cut
• Not be able to eat the first 1 to 3 days, and then you will begin with liquids
• Be encouraged to do breathing exercises
• Wear special stockings to prevent blood clots
• Receive shots under your skin to prevent blood clots
• Receive pain medicine into your veins or pills

Recovering from open surgery may be painful because of where the surgical cut is. Recovery after a laparoscopic procedure is usually quicker, with less pain.

Outlook (Prognosis)

The outcome is usually good when a single kidney is removed. If both kidneys are removed, or the remaining kidney does not work well enough, you will need hemodialysis or a kidney transplant.

References

Novick AC. Open surgery of the kidney. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.