Introduction
A nephrectomy is the removal of a kidney and part if the blood vessels and ureter for either a benign or malignant condition. This procedure is typically performed laparoscopically (key hole approach) but may need to be performed open (though a large incision) if removal of the kidney is particularly challenging or if there is a significant risk to the surrounding structures.
Indications
The indications for a nephrectomy include:
- Kidney cancer.
- Severe trauma to the kidney.
- Chronic infection.
- Polycystic kidney.
- Atrophic kidney.
- Staghorn calculus in a poorly functioning kidney.
Preoperative Instructions
Numerous blood tests will usually be performed prior to a nephrectomy to determine a patient’s current haemoglobin levels and their current kidney function. Certain medications that promote bleeding such as warfarin, clopidogrel, rivaroxaban and apixaban will need to be stopped for certain period prior to the procedure to reduce the risk of significant bleeding. This procedure can still be performed if the patient is taking aspirin, however this too will often be ceased prior to a nephrectomy. The patient can expect to have additional scans performed prior to a nephrectomy which may include an ultrasound, CT scan or nuclear medicine scan.
Procedure
A nephrectomy can be performed in a number of different ways (laparoscopic vs open, transperitoneal versus retroperitoneal, flank incision versus anterior incision). Your surgeon will discuss with you the best approach to deal with the condition that you have. The laparoscopic or keyhole approach is associated with less complications in particular less post-operative pain and earlier discharge than the open approach. A patient who undergoes a laparoscopic nephrectomy can often be discharged on the second day after the surgery however the open approach often requires the patient to remain in hospital for 5-7 days.
Postoperative Instructions
The post-operative instructions will depend upon the approach used to remove the kidney. Typically, the patient will be advised to perform no heavy lifting or straining for a period of six weeks after the operation. Any significant pain or fever should be reported to the surgeon immediately the procedure. The surgeon will usually follow up with the patient approximately two weeks after the procedure to assess their progress following discharge and to provide the pathology results of the kidney and determine any ongoing management that may be required.
Risks
The risks of a nephrectomy include:
- Bleeding.
- Infection.
- Injury to surrounding structures.
- Kidney impairment.
- Pain in the shoulder (laparoscopic approach).
- Hernia.
- Pneumonia.
Treatment Alternatives
The treatment alternatives to a nephrectomy will depend up your underlying condition. Your surgeon will discuss these with you in detail at the time of your consultation.