A nephrectomy is a surgical procedure for
the removal of a kidney or section of a
Nephrectomy, or kidney removal, is performed
on patients with severe kidney damage from
disease, injury, or congenital conditions.
These include cancer of the kidney (renal
cell carcinoma); polycystic kidney disease
(a disease in which cysts, or sac-like structures,
displace healthy kidney tissue); and serious
kidney infections. It is also used to remove
a healthy kidney from a donor for the purposes
of kidney transplantation.
The HCUP Nationwide Inpatient Sample from
the Agency for Healthcare Research and Quality
(AHRQ) reports that 46,130 patients underwent
partial or radical nephrectomy surgery for
non-transplant-related indications in the
United States in 2000. Patients with kidney
cancer accounted for over half of those
procedures. The American Cancer Society
projects that an estimated 31,900 new cases
of renal cell carcinoma will occur in the
United States in 2003.
to the United Network for Organ Sharing
(UNOS), 5,974 people underwent nephrectomy
to become living kidney donors in 2001.
The majority of these donors—43.9%—were
between the ages of 35 and 49, and 58.8%
were female. Related donors were more common
than non-related donors, with full siblings
being the most common relationship between
living donor and kidney recipients (28.5%
of living donors).
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 living donor transplant purposes requires
removal of the kidney and a section of the
In a traditional, open nephrectomy, the
kidney donor is administered general anesthesia
and a 6–10 in (15.2–25.4 cm) incision through
several layers of muscle is made on the
side or front of the abdomen. The blood
vessels connecting the kidney to the donor
are cut and clamped, and the ureter is also
cut between the bladder and kidney and clamped.
Depending on the type of nephrectomy procedure
being performed, the ureter, adrenal gland,
and/or surrounding tissue may also be cut.
The kidney is removed and the vessels and
ureter are then tied off and the incision
is sutured (sewn up). 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, and carbon dioxide is pumped
into the abdominal cavity to inflate it
and improve visualization of the kidney.
Once the kidney is isolated, 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.
modified laparoscopic technique called hand-assisted
laparoscopic nephrectomy may also
be used to remove the kidney. In the hand-assisted
surgery, a small incision of 3–5 in (7.6–12.7
cm) is made in the patient's abdomen. The
incision allows the surgeon to place his
hand in the abdominal cavity using a special
surgical glove that also maintains a seal
for the inflation of the abdominal cavity
with carbon dioxide. This technique gives
the surgeon the benefit of using his hands
to feel the kidney and related structures.
The kidney is then removed by hand through
the incision instead of with a bag.
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.
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
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
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 surgery. If the
remaining kidney is healthy, it will increase
its functioning over time to compensate
for the loss of the removed kidney.
of hospitalization depends on the type of
nephrectomy procedure. Patients who have
undergone a laparoscopic radical nephrectomy
may be discharged 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.
and mortality rates
Survival rates for living kidney donors
undergoing nephrectomy are excellent; mortality
rates are only 0.03%—or three deaths for
every 10,000 donors. Many of the risks involved
are the same as for any surgical procedure:
risk of infection, hemorrhage, blood clot,
or allergic reaction to anesthesia.
patients undergoing nephrectomy as a treatment
for renal cell carcinoma, survival rates
depend on several factors, including the
stage of the cancer and the patient's overall
health history. According to the American
Cancer Society, the five-year survival rate
for patients with stage I renal cell carcinoma
is 90–100%, while the five-year survival
rate for stage II kidney cancer is 65–75%.
Stage III and IV cancers have metastasized,
or spread, beyond the kidney and have a
lower survival rate, 40–70% for stage III
and less than 10% for stage IV. Chemotherapy,
radiation, and/or immunotherapy may also
be required for these patients.
the kidney is responsible for filtering
wastes and fluid from the bloodstream, kidney
function is critical to life. Nephrectomy
candidates diagnosed with serious kidney
disease, cancer, or infection usually have
few treatment choices aside from this 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.
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