Nephrectomy

Nephrectomy is a surgical procedure for the removal of one kidney.
Bilateral nephrectomy is done surgically to remove both kidneys.

Some facts about Nephrectomy:

• Nephrectomy is commonly done to remove a tumor from the kidney which may be either cancerous or benign.
• Nephrectomy is required for the people if their kidney is the source of repeat infections or is no longer working.
• Nephrectomies is also done by surgeon to remove a healthy kidney for a kidney donation.
• Nephrectomy is done by a urologic surgeon to remove a cancerous tumor or abnormal tissue growth in a kidney.
• Renal cell carcinoma is the  most common kidney cancer in adults that begins in the cells that line the small tubes within your kidneys.
• Wilms' tumor is a type of kidney cancer developed in children mostly due to the poor development of kidney cells.
• You will need a kidney transplant or dialysis to remain alive if both o your kidneys are removed.
• A nephrectomy can be a life saving procedure in cases of kidney cancer.
• Several things need to be consider while taking the decision about how much kidney tissue to remove. These include, whether there is more than one tumor and whether it is confined to the kidney, how much of the kidney is affected, whether the cancer affects nearby tissue, how well the other kidney functions, whether kidney function is affected by other diseases and overall kidney function.
• There is a small risk of kidney failure if you have disease or damage in your remaining kidney
• You should I see a healthcare provider if you experience any symptoms of kidney failure such as brain fog, increasingly high blood pressure, nausea or vomiting, edema or swelling in the legs, lower back or face, and hanges in urination, including frequent urination or changes in urine color.

Preparation for a Nephrectomy:

• Specific instructions will be provided to the patient prior to the surgery by discussing risks such as bleeding, infection, or adverse reaction to anesthesia.
• Patients are not allowed to eat after midnight the night before the surgery.
• You will have to stop taking certain medications, such as blood thinners, the days before the operation as it can increase the risk of bleeding.
• Your blood type will be determined by blood test in case you need a blood transfusion. The baseline kidney function and blood counts will also be determined.

Procedure for a Nephrectomy:

• Either a laparoscopic or open surgery can be used by a surgeon to perform a nephrectomy.
• You will receive general anesthesia before either kidney removal procedure to ensure you don't feel any pain during the procedure.
• One or a few small incisions will be made in your abdomen or side during a laparoscopic nephrectomy by your surgeon. A laparoscope containing a long wand with a camera will be inserted through the incision.
• The camera image can be viewed from the laparoscope on a large screen.
• The camera image and small surgical tools will be used to remove the diseased portion of your kidney or your entire kidney.
• All incisions will be closed with small stitches that will dissolve on their own.
• Only one incision will be made in your abdomen during an open nephrectomy by your surgeon. The diseased portion of your kidney or your whole kidney will be removed and the incision will be closed with stitches.

Types of Nephrectomy:

Partial nephrectomy and Radical nephrectomy are two types of Nephrectomy.

• When only the diseased portion of the kidney is removed, it is called as Partial nephrectomy. Partial nephrectomy can be either open or laparoscopic/robotic.
• When the entire kidney is removed, it is called as Radical nephrectomy.
• The section of the ureter will be removed in a procedure called nephroureterectomy. 
• The adrenal glands is hormone glands that sit above the kidneys may also be required to be removed which may be performed as an open or laparoscopic/robotic procedure.A laparoscope is used during a laparoscopic nephrectomy with a few tiny incisions.
• A surgical robot is controlled by the surgeon to manipulate these small tools in a robotic-assisted laparoscopic case.
• One large incision is made during an open nephrectomy and camera is not used in this procedure as the surgeons view directly inside the body.
• Shorter hospital stays and quicker recovery times is the advantage of a laparoscopic nephrectomy.
• Open surgery is required if laparoscopic surgery is not an option.
• Laparoscopic surgery is not suitable for people who do not respond well to being under anesthesia for long periods as it requires longer periods under anesthesia.
• These minimally-invasive techniques may not be the best option for large kidney tumor

Recovery from Nephrectomy:

• The duration to stay in hospital after surgery can be a month or more and the recovery time will depend on your health condition before the surgery.
• You will be moved to the intensive care unit right after surgery.
• Fluids and medications will be given through intravenous (IV) lines.
• Urine from your bladder and fluid and blood from your chest can be drained by other tubes.
• Oxygen can be given through a mask or nasal prongs in your nose.
• Your blood pressure, electrolytes and fluid levels will be monitored and the signs of infection in your incision sites will be watched by your treatment team.
• The pain you have after surgery can be managed by your treatment team.
• You may need to remain connected to a ventilator for several days after surgery until you are able to breathe on your own as your lungs may not work properly immediately after your surgery.
• It may be uncomfortable to breathe deeply as your incision will be near your diaphragm. So,  diaphragmatic breathing exercises can be done to prevent pneumonia.