Nephrectomy - Types and Procedure

Introduction:

A nephrectomy is the surgical removal of a part or all of the kidney. The procedure is carried out to treat kidney cancer and other kidney diseases and injuries. Sometimes, a nephrectomy is performed to treat a seriously damaged kidney. The surgeon removes a healthy kidney from a donor to transplant it to a person who needs a functioning kidney.

What Are the Types of Nephrectomy?

There are two types of nephrectomies:-

1. Radical or Complete Nephrectomy- In a radical nephrectomy, the surgeon removes the entire kidney and some associated structures, such as a part of the ureter- a tube that connects the kidney to the bladder, adrenal glands, or lymph nodes.

2. Partial Nephrectomy- In partial nephrectomy, also known as kidney-sparing surgery, the surgeon removes the diseased part of the kidney, leaving the healthy tissue in place.

The procedure can be done through a single incision in the abdomen- open nephrectomy) or through a series of incisions in the stomach with the help of an instrument using a camera- laparoscopic nephrectomy). This laparoscopic procedure is sometimes performed using a robotic system. In robotic surgery, the surgeon sits near the computer adjacent to the operating table. He controls the camera arm with surgical instruments in the patient's body.

Why Is Nephrectomy Performed?

The conditions requiring nephrectomy are -

• Congenital disabilities.

• Kidney cancer.

• Infection, kidney stones, or other conditions cause kidney damage.

• To control high blood pressure in people with kidney blood supply difficulty.

• Trauma to the kidney that cannot be repaired.

• Kidney Transplant.

How Is Nephrectomy Performed?

During the procedure, a nephrectomy is performed under general anesthesia. A urinary catheter (a small tube that drains urine from the bladder) is placed before the surgery. The nephrectomy procedures depend on how the surgery is performed and how many parts of the kidneys should be removed. The surgeon explains the advantages and disadvantages of robotic or other minimally invasive techniques compared to open surgery, including scarring and recovery time.

Laparoscopic Surgery- This is a minimally invasive surgery in which a few small incisions are made in the abdomen to insert a device attached to video cameras and tiny surgical tools. A larger incision is made if the whole kidney needs to be removed.

Robot-Assisted Laparoscopic Surgery- This is a variation of laparoscopic surgery. The surgeon uses a robot system to perform the procedure. Tiny incisions are made to provide better three-dimensional images during the procedure. It can make motions similar to a surgeon's hand in the case of open surgery.

Open Surgery- The surgeon makes an incision along the side or abdomen during open surgery. This allows the surgeon to perform certain surgeries that cannot be performed with less invasive procedures.

Radical Nephrectomy- In a radical nephrectomy, the surgeon removes the whole kidney, the surrounding fatty tissue, and a part of the ureter. The adrenal glands placed at the kidney's top are also removed if a tumor is close to the gland. In certain cases, the lymph nodes or other tissues are also removed.

Partial Nephrectomy- In this procedure, the surgeon removes a cancerous tumor or diseased tissue, leaving behind healthy kidney tissues.

After The Procedure- After the procedure is over, the recovery time and the length of hospital stay depend on the overall health and the type of nephrectomy performed. The urinary catheter is not removed for a short period during recovery. Proper instructions are given regarding diet and activities. Strenuous activities, such as lifting heavy objects, exercising, etc., should be avoided for a few weeks. Once recovered, one can resume normal activities slowly. Deep breathing might be uncomfortable since the incision is made near the diaphragm (a muscular band under the lungs that helps in the breathing process). Thus, diaphragmatic breathing exercises should be learned to prevent pneumonia or lung infections.

What Are the Risks and Complications of Nephrectomy Surgery?

1. Bleeding: During or after a nephrectomy, there is a chance that there will be significant bleeding.

2. Infection: An infection could arise and necessitate additional medical consideration.

3. Organ injury: Adjacent organs can sustain unintended injury during surgery.

4. Adverse Reactions to Anesthesia: Although rare, adverse reactions to anesthesia are conceivable.

5. Long-term Complications: Alterations in blood pressure and an increased chance of developing chronic renal disease are two potential long-term complications.

6. Pre-surgery talk: Before having a nephrectomy, it is imperative to have a thorough talk with the medical team to comprehend and manage these possible risks.

How Might My Life Change After My Kidney Is Removed?

• People may feel tired and sore after surgery as their bodies recover.

• Modifying the usual routine and activities could be necessary, especially in the initial postoperative phase.

• Making regular follow-up appointments with medical specialists is essential to monitoring health and kidney function.

• A doctor could suggest changing your diet to support kidney function in general.

• Consultation with a physician is necessary for any potential long-term effects on blood pressure and the risk of developing chronic renal disease.

What to Do After the Surgery?

The functions of the kidney are monitored through the following:

Blood Pressure- Blood pressure needs to be monitored closely as a decrease in kidney function can increase blood pressure, damaging the kidneys.

Protein Levels in Urine- High protein concentration in the urine (proteinuria) indicates kidney damage and poor kidney function.

Glomerular Filtration Rate- It is a measure of the efficiency of the kidneys in waste filtration. This test uses a blood sample to test the level of creatinine. Creatinine is the waste product produced by the normal wear and tear of the muscles. A reduction in the glomerular filtration rate suggests lower kidney function.

Taking Care of the Rest of the Kidney- The kidney function might return to normal after the surgery. A balanced and healthy diet is recommended to preserve this normal kidney function. Engaging in physical activities and undergoing regular checkups is a must to keep tabs on the health of the kidneys. On developing chronic kidney disease or reduced kidney function after a complete or partial nephrectomy (removal of kidney and replacement by a sparing nephron of the kidney), additional lifestyle changes such as changes in diet and being vigilant about any drug intake are recommended.

How Is the Prognosis After Nephrectomy?

The prognosis of nephrectomy is good when a single kidney is removed. In cases of the removal of both kidneys or if the remaining kidney is unable to work properly, one would need dialysis (a procedure to remove waste and excess fluids from the blood when the kidneys are not functioning properly) or a kidney transplant (a procedure where a healthy kidney is removed from a donor and fixed to a recipient).

How to Live With Kidneys Removed?

After a nephrectomy, individuals with one kidney need to monitor their kidney function. Urinalysis (urine test) and blood tests are recommended once every year. Activities that might increase the chances of kidney injury, such as hockey, football, wrestling, and the like, can be avoided.

Conclusion:

Nephrectomy is the procedure where a part or whole of the kidney is removed. Nephrectomy is advised by surgeons for tumor removal or kidney removal for transplant. While almost everybody has two kidneys, one can also function well with one kidney. Getting back to routine life takes about six weeks post-surgery. One should pay attention to follow-up procedures to maintain a healthy kidney