Nephrectomy is a surgical procedure used to remove all or a portion of a kidney. Usually, a nephrectomy is performed to treat kidney cancer or to remove a noncancerous tumor. In certain cases, this procedure is performed to deal with a diseased or seriously damaged kidney. There are two distinct types of nephrectomy procedures, partial nephrectomy and radical nephrectomy, and the differentiation depends on the severity of the patient’s situation.
Partial Nephrectomy
When a partial nephrectomy is performed, the urological surgeon removes diseased tissue from a kidney and leaves healthy tissue in place. Also referred to as “nephron-sparing surgery,” this procedure is used when a tumor is does not threaten the entire kidney and can be removed without damaging the remainder. Studies have shown that a partial nephrectomy can remove a tumor and achieve results that are similar to a total kidney removal. This has been established for tumors less than four cm, and more recently, there is research emerging that suggests the same could be true for larger tumors as well.
It is important to note that not all partial nephrectomy procedures are the same. For example, the surgeon may cut half the kidney for a small, 1 cm tumor while another may be able to save 90 percent of the kidney, which leads to a significant difference for your kidney health.
A partial nephrectomy can be performed via open or robotic-assisted laparoscopic surgery and having a surgeon trained in both is ideal. Robotic partial nephrectomy has become the robotic kidney surgery of choice for most patients with kidney cancer or a benign kidney tumor. Here’s how robotic partial nephrectomy is performed: after a series of small incisions are made in the abdomen and the camera and instrument-bearing arms of the robot are inserted, the abdomen in inflated with gas. The colon is then moved away from the kidney, and the fat covering the kidney is trimmed away to expose the kidney surface. Next, blood flow to the kidney is momentarily halted to prevent bleeding while the tumor is cut out and the remaining kidney tissue is sutured together. After the kidney is reconstructed, blood flow is returned to normal and the kidney is very carefully inspected to ensure there is no bleeding.
A robotic partial nephrectomy causes less trauma and scarring while having the benefit of a faster recovery time. Compared to an open surgery, a robotic kidney procedure uses smaller incisions and does not require cutting through muscle or bone, resulting in less scarring and trauma to the patient and a faster recovery time – usually just two weeks, as opposed to six to eight weeks for the open procedure.
Radical Nephrectomy
In cases where kidney function is threatened or the tumor has grown too large to be removed, a full kidney removal, or radical nephrectomy, may be required for some patients. The surgeon may also remove the adrenal gland and the neighboring lymph nodes during the surgery as well. As stated above, a radical nephrectomy is typically performed for larger tumors or those that are more advanced. Sometimes total kidney removal can be helpful to patients with cancer that has already spread, although a thorough evaluation by our urology team is advised to determine the best surgical route.
During a radical nephrectomy, the surgeon begins by making an incision to remove the kidney. The incision is typically made in the flank (the area between the 10th and 11th ribs) but other incisions can be used – subcostal, midline, or thoracoabdominal incisions are all alternatives to the flank. The surgeon removes the entire kidney, the fatty tissues surrounding the kidney, and a portion of the tubing connecting the kidney to the bladder (ureter). The surgeon may also remove the adrenal gland that sits atop the kidney if a tumor is close to or involves the adrenal gland. In some severe cases, the lymph nodes or other tissues are removed as well.
Recovery time after the procedure and the length of your hospital stay will greatly depend on your overall health and type of nephrectomy performed. The urinary catheter remains in place for a short time during your recovery.
Patients can expect to receive instructions before leaving the hospital about restrictions to your diet and activities. Patients may be encouraged to begin light, everyday activities as soon as you feel able, but it is important to avoid strenuous activity or heavy lifting for several weeks.
For most patients, the procedure does not affect your quality of life – once you are completely recovered, you can expect to resume your normal routine and activities.
Complications with Nephrectomy
All types of surgery have certain risks and complications associated with them. Possible complications of nephrectomy surgery include:
- Infection
- Bleeding (hemorrhage) requiring blood transfusion
- Postoperative pneumonia
- Rare allergic reactions to anesthesia
- Death
There is also the small risk of kidney failure in a patient with lowered function or disease in the remaining kidney.
Whether your particular condition requires a partial or radical nephrectomy, it is important to consult with your urology physician to determine what is the right choice for you. Urology Centers of Alabama can help diagnose your specific situation and design a unique treatment plan to address your condition.