Nephrectomy

Overview :

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 transplant purposes requires removal of the kidney and a section of the attached ureter. A similar procedure is used to harvest cadaver kidneys, although both kidneys are typically removed at once (bilateral nephrectomy) and blood and cell samples for tissue typing are also taken.

The nephrectomy patient is administered general anesthesia and the surgeon makes an incision on the side or front of the abdomen. Muscle, fat, and tissue are cut away to reveal the kidney. The blood vessels connecting the kidney to the circulation are cut and clamped. Depending on the type of nephrectomy procedure being performed, the ureter, adrenal gland, and/or surrounding tissue may also be cut. The vessels and the ureter in the patient are then tied off and the incision is sewn up (sutured). 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. Once the kidney is freed, 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 postoperative pain for kidney donors.